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2707 East 21st Street North Wichita KS 67214-2249 | |
| (316) 691-0249 | |
| (316) 691-9939 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2707 East 21st Street North, Wichita, Kansas |
| Authorized Official Name and Position | Teresa Lovelady (CEO) |
| Authorized Official Contact | 3166910249 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2707 East 21st Street North Wichita KS 67214-2249 Ph: (316) 691-0249 | 2707 East 21st Street North Wichita KS 67214-2249 Ph: (316) 691-0249 |
| NPI Number | 1033218565 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 08/14/2015 |
| Medicare PECOS PAC ID | 9739092131 |
|---|---|
| Medicare Enrollment ID | O20031111000669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033218565 | NPI | - | NPPES |
| 100321990 | Medicaid | KS | |
| 100321990C | Medicaid | KS | |
| 100321990A | Medicaid | KS |
| Provider Name | Amy S Mccue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841221520 PECOS PAC ID: 4284638685 Enrollment ID: I20060825000430 |
| Provider Name | Caryn N Bryant |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1215138375 PECOS PAC ID: 5799853404 Enrollment ID: I20081008000467 |
| Provider Name | Rachna Kalia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770741548 PECOS PAC ID: 4587833587 Enrollment ID: I20110809000174 |
| Provider Name | Kelly R Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316362767 PECOS PAC ID: 3870724461 Enrollment ID: I20140325000326 |
| Provider Name | Rachel M Cheek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083091516 PECOS PAC ID: 9335456466 Enrollment ID: I20150922000939 |
| Provider Name | Danielle M Villalobos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043656143 PECOS PAC ID: 9436390309 Enrollment ID: I20160706001953 |
| Provider Name | Daniel Warren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669609970 PECOS PAC ID: 3678710779 Enrollment ID: I20170818002611 |
| Provider Name | Colleen V Loo-gross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427314426 PECOS PAC ID: 7618284969 Enrollment ID: I20180409000305 |
| Provider Name | Danielle Renea Kauffman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316435449 PECOS PAC ID: 3476809369 Enrollment ID: I20180706002313 |
| Provider Name | Penny E Jeffery |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548348345 PECOS PAC ID: 0042259541 Enrollment ID: I20180924000730 |
| Provider Name | Claire E Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962864249 PECOS PAC ID: 3779818471 Enrollment ID: I20190717003631 |
| Provider Name | Amanda K Barrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003491606 PECOS PAC ID: 2860800224 Enrollment ID: I20210423000825 |
| Provider Name | Katherine Sisk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174223366 PECOS PAC ID: 6901270800 Enrollment ID: I20230315002990 |
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