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General NPI Number Information
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NPI Number | 1538954672
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Entity Type | Organization
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Legal Business Name | PRIME FIT YOUTH FOUNDATION
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 7719 W 11TH ST N
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City | WICHITA
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State | KS
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Zip | 67212-3006
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Country | US
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Telephone | 316-214-2568
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Fax |
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Provider Business Mailing Address
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Address Line | 7719 W 11TH ST N
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City | WICHITA
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State | KS
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Zip | 67212-3006
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Country | US
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Telephone | 316-214-2568
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Fax |
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | KIMBERLY MOODY
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Credential |
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Telephone | 316-655-1636
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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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