Provider Demographics
NPI:1164135679
Name:NDIKUM, KENNETH CHI (APRN)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHI
Last Name:NDIKUM
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 SW HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2492
Mailing Address - Country:US
Mailing Address - Phone:785-266-4100
Mailing Address - Fax:
Practice Address - Street 1:3360 SW HARRISON ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2492
Practice Address - Country:US
Practice Address - Phone:785-266-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81501363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health