Healthcare Provider Details

I. General information

NPI: 1285682252
Provider Name (Legal Business Name): TERRY A ANDERSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N WOODLAWN ST STE 102
WICHITA KS
67208-3671
US

IV. Provider business mailing address

555 N WOODLAWN ST STE 102
WICHITA KS
67208-3671
US

V. Phone/Fax

Practice location:
  • Phone: 316-652-2590
  • Fax: 316-652-2595
Mailing address:
  • Phone: 316-652-2590
  • Fax: 316-652-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number74492
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: