Healthcare Provider Details

I. General information

NPI: 1629951751
Provider Name (Legal Business Name): MARY CARLYN SVOBODA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 N WEBB RD STE 100
WICHITA KS
67226-8191
US

IV. Provider business mailing address

508 N MISSION RD
WICHITA KS
67206-1506
US

V. Phone/Fax

Practice location:
  • Phone: 316-667-6700
  • Fax: 316-667-6701
Mailing address:
  • Phone: 316-613-9251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number84556
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: