Provider Demographics
NPI:1083478705
Name:ROBINETTE, CONNOR MICHAEL
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:MICHAEL
Last Name:ROBINETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3515
Mailing Address - Country:US
Mailing Address - Phone:316-308-4184
Mailing Address - Fax:316-352-9315
Practice Address - Street 1:659 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3515
Practice Address - Country:US
Practice Address - Phone:316-308-4184
Practice Address - Fax:316-352-9315
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician