Provider Demographics
NPI:1235824525
Name:SEASON HEALTH LLC
Entity Type:Organization
Organization Name:SEASON HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:V
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-208-3226
Mailing Address - Street 1:10209 W CENTRAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4685
Mailing Address - Country:US
Mailing Address - Phone:316-841-6861
Mailing Address - Fax:316-854-9673
Practice Address - Street 1:10209 W CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4685
Practice Address - Country:US
Practice Address - Phone:316-841-6861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty