MEDICARE: KATHRINE F. GIRRENS, MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	04-34127	KS

General Provider Information

NPI Number	:	1144515198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHRINE F. GIRRENS, MD, LLC

Provider Business Mailing Address
First Line	:	1148 S HILLSIDE ST
Second Line	:	SUITE 104
City	:	WICHITA
State	:	KS
Zip	:	67211-4006
Country	:	US
Telephone Number	:	316-687-0006
Fax Number	:	316-687-0328

Provider Business Practice Location Address
First Line	:	1148 S HILLSIDE ST
Second Line	:	SUITE 104
City	:	WICHITA
State	:	KS
Zip	:	67211-4006
Country	:	US
Telephone Number	:	316-687-0006
Fax Number	:	316-687-0328

Authorized Official
Title or Position	:	SOLE PROVIDER
Name	:	DR. KATHRINE FRANCES GIRRENS
Credential	:	M.D.
Telephone Number	:	316-687-0006

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	09/13/2011

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