MEDICARE: SEASONED SOUL BEHAVIORAL HEALTH & WELLNESS 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	363LG0600X	Gerontology Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1871459909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASONED SOUL BEHAVIORAL HEALTH & WELLNESS LLC

Provider Business Mailing Address
First Line	:	6806 W GARDEN RIDGE CIR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1069
Country	:	US
Telephone Number	:	316-202-5293
Fax Number	:	316-395-0243

Provider Business Practice Location Address
First Line	:	6806 W GARDEN RIDGE CIR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1069
Country	:	US
Telephone Number	:	316-202-5293
Fax Number	:	316-395-0243

Authorized Official
Title or Position	:	OWNER
Name	:	SHARON CARPENTER
Credential	:	APRN
Telephone Number	:	316-259-6576

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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