=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679816029
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICE ANTOINETTE NEAL BORDERS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2013
-----------------------------------------------------
Last Update Date | 04/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1907 S HYDRAULIC ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67211-4557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-524-7286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1213 W PATTERSON ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67217-2662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-524-7286
-----------------------------------------------------
Fax | 316-524-7283
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 7709
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------