=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316439086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTERPOINTE PHYSICIANS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2018
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2331 TUTTLE CREEK BLVD
-----------------------------------------------------
City | MANHATTAN
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66502-4462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-537-4940
-----------------------------------------------------
Fax | 785-537-0836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2331 TUTTLE CREEK BLVD
-----------------------------------------------------
City | MANHATTAN
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66502-4462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-537-4940
-----------------------------------------------------
Fax | 785-537-0836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | KYRA RICKETTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-537-4940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------