Healthcare Provider Details

I. General information

NPI: 1174223366
Provider Name (Legal Business Name): KATHERINE SISK MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 E 21ST ST N
WICHITA KS
67214-2249
US

IV. Provider business mailing address

1216 SUMMERWOOD CIR
GODDARD KS
67052-8511
US

V. Phone/Fax

Practice location:
  • Phone: 316-691-0249
  • Fax: 866-514-0974
Mailing address:
  • Phone: 316-371-0473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number53-82000-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: