Healthcare Provider Details

I. General information

NPI: 1447880356
Provider Name (Legal Business Name): CAITLIN HIMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N SAINT FRANCIS AVE
WICHITA KS
67214-3821
US

IV. Provider business mailing address

3000 W DOUGLAS AVE APT 212
WICHITA KS
67203-6307
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5000
  • Fax:
Mailing address:
  • Phone: 319-333-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01625
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: