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NPI Code Detail

MEDICARE: KURT D LEIS ARNP

MEDICARE: KURT D LEIS ARNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner74826KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1161920OTHERKSBCBS

General Provider Information

NPI Number : 1568466043
Entity Type Code : Individual
Provider Name (Legal Business Name) : KURT D LEIS ARNP
Provider Business Mailing Address
First Line : 1010 N KANSAS
Second Line : SUITE 3049
City : WICHITA
State : KS
Zip : 67214-3199
Country : US
Telephone Number : 316-293-2647
Fax Number : 316-293-1863
Provider Business Practice Location Address
First Line : 1001 N MINNEAPOLIS
Second Line :
City : WICHITA
State : KS
Zip : 67214-3124
Country : US
Telephone Number : 316-293-2647
Fax Number : 316-293-1863
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 12/03/2007

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