MEDICARE: KYLE HADEN ATC

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	2255A2300X	Athletic Trainer		KS

General Provider Information

NPI Number	:	1619858479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE HADEN ATC

Provider Business Mailing Address
First Line	:	7627 E 37TH ST N APT 2403
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-2807
Country	:	US
Telephone Number	:	785-614-4410
Fax Number	:

Provider Business Practice Location Address
First Line	:	7627 E 37TH ST N APT 2403
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67226-2807
Country	:	US
Telephone Number	:	785-614-4410
Fax Number	:

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

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	09/09/2025

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Directions to “ KYLE HADEN ATC” Practice Location

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