Provider Demographics
NPI:1366445215
Name:GRIFFITT, ALICE JOYCE (MSN, ARNP, BC, CNS)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:JOYCE
Last Name:GRIFFITT
Suffix:
Gender:F
Credentials:MSN, ARNP, BC, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3123
Mailing Address - Country:US
Mailing Address - Phone:620-792-2544
Mailing Address - Fax:620-792-4323
Practice Address - Street 1:5815 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3123
Practice Address - Country:US
Practice Address - Phone:620-792-2544
Practice Address - Fax:620-792-4323
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74614364SP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100375860CMedicaid
KS161876OtherMEDICARE
KS161876OtherBLUE CROSS BLUE SHIELD
KS161876OtherMEDICARE
KS100375860CMedicaid