Healthcare Provider Details

I. General information

NPI: 1730569385
Provider Name (Legal Business Name): CASANDRA R FIKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASANDRA BARLETTA FNP-C

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N WEST ST
WICHITA KS
67203
US

IV. Provider business mailing address

753 N WEST ST
WICHITA KS
67203-1240
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-5691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127531
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-78199
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: