=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992509137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATM MENTAL WELL-BEING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2025
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4601 E DOUGLAS AVE STE 150
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-674-3766
-----------------------------------------------------
Fax | 913-674-3774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4601 E DOUGLAS AVE STE 150
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-1032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIC MENTAL HEALTH NURSE PRA
-----------------------------------------------------
Name | ANAYA TINA KOLE
-----------------------------------------------------
Credential | PMHNP-BC, MSN, APRN,
-----------------------------------------------------
Telephone | 913-674-3766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------