=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164963849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAY A JOHNSON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2017
-----------------------------------------------------
Last Update Date | 04/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3334 N GREY MEADOW CT
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67205-8716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-992-7900
-----------------------------------------------------
Fax | 913-730-7624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 598
-----------------------------------------------------
City | MAIZE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67101-0598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-992-7900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 77587
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------