=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376518928
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL HAMMON PAULSON PHD, RN, ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2006
-----------------------------------------------------
Last Update Date | 04/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4972 N. WYNDHAM CT.,
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67219-5500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-832-2340
-----------------------------------------------------
Fax | 316-838-4909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4972 N WYNDHAM CT.
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67219-5500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-832-2340
-----------------------------------------------------
Fax | 316-838-4909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 777
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 14051451041
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 74458
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------