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General NPI Number Information
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NPI Number | 1770249237
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Entity Type | Organization
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Legal Business Name | HEALTH ATLAST WICHITA LLC
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 10111 E 21ST ST N STE 315
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City | WICHITA
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State | KS
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Zip | 67206-3581
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Country | US
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Telephone | 316-807-0835
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Fax | 316-330-6704
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Provider Business Mailing Address
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Address Line | 10111 E 21ST ST N STE 315
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City | WICHITA
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State | KS
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Zip | 67206-3581
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Country | US
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Telephone | 316-807-0835
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | JESSIKA RICHARDSON-COOKS
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Credential | RN
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Telephone | 316-806-0176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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