| NPI | 1255601944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY KELLENBERGER Physician 620-224-3511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-75555-122) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2012-08-01 |