MEDICARE: BRENDA L TRAMMEL LCP

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	103TC0700X	Clinical Psychologist	1457	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	392674	OTHER	KS	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194763680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA L TRAMMEL LCP

Provider Business Mailing Address
First Line	:	6611 E CENTRAL AVE STE C
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-1937
Country	:	US
Telephone Number	:	316-993-2715
Fax Number	:	866-316-4467

Provider Business Practice Location Address
First Line	:	6611 E CENTRAL AVE STE C
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-1937
Country	:	US
Telephone Number	:	316-993-2715
Fax Number	:	866-316-4467

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	09/25/2024

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Directions to “ BRENDA L TRAMMEL LCP” Practice Location

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