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General NPI Number Information
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NPI Number | 1083378228
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Entity Type | Organization
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Legal Business Name | PSYCH-APRN, LLC
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 402 N RACEHORSE ST
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City | WICHITA
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State | KS
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Zip | 67235-8516
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Country | US
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Telephone | 316-554-6711
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Fax |
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Provider Business Mailing Address
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Address Line | 402 N RACEHORSE ST
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City | WICHITA
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State | KS
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Zip | 67235-8516
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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 | OWNER
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Name | JACY BARKER
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Credential | APRN
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Telephone | 316-554-6711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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