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General NPI Number Information
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NPI Number | 1013821578
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Entity Type | Individual
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Provider Name | CLARISSA LEIDHOLT
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Gender | Female
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 2055 S 143RD ST E
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City | WICHITA
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State | KS
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Zip | 67230-9547
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Country | US
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Telephone | 316-973-9990
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Fax | 316-973-9995
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Provider Business Mailing Address
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Address Line | 2055 S 143RD ST E
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City | WICHITA
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State | KS
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Zip | 67230-9547
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 13-134043
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License Number State | KS
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