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General NPI Number Information
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NPI Number | 1558042218
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Entity Type | Organization
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Legal Business Name | PLEASANT PLACE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 6611 E CENTRAL AVE STE C
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City | WICHITA
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State | KS
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Zip | 67206-1937
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Country | US
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Telephone | 507-353-2419
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Fax | 507-607-8967
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Provider Business Mailing Address
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Address Line | 4925 S BROADWAY AVE # 1077
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City | WICHITA
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State | KS
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Zip | 67216-3716
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Country | US
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Telephone | 507-353-2419
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Fax | 507-607-8967
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Authorized Official
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Title or Position | OWNER
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Name | EDIOMI E ENEBONG
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Credential |
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Telephone | 832-206-1265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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