Healthcare Provider Details

I. General information

NPI: 1548701717
Provider Name (Legal Business Name): SHANNON HORSCH APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S OLIVER ST
WICHITA KS
67210-2112
US

IV. Provider business mailing address

4810 N 231ST ST W
ANDALE KS
67001-9405
US

V. Phone/Fax

Practice location:
  • Phone: 316-526-3511
  • Fax:
Mailing address:
  • Phone: 316-706-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-45624-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: