Healthcare Provider Details

I. General information

NPI: 1902542749
Provider Name (Legal Business Name): HAWORTH HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S EMPORIA AVE STE 103
WICHITA KS
67202-4534
US

IV. Provider business mailing address

535 S EMPORIA AVE STE 103
WICHITA KS
67202-4534
US

V. Phone/Fax

Practice location:
  • Phone: 316-841-6861
  • Fax: 743-244-2912
Mailing address:
  • Phone: 316-841-6861
  • Fax: 743-244-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMANDA K HAWORTH
Title or Position: OWNER, CEO
Credential: APRN, CNM, PMHNP-BC
Phone: 316-841-6861