Provider Demographics
NPI:1477926301
Name:PRAIRIE HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PRAIRIE HEALTH AND WELLNESS, LLC
Other - Org Name:PRAIRIE HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-440-7000
Mailing Address - Street 1:12115 E 21ST ST N STE 107
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3571
Mailing Address - Country:US
Mailing Address - Phone:316-440-7000
Mailing Address - Fax:
Practice Address - Street 1:12115 E 21ST ST N STE 107
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3571
Practice Address - Country:US
Practice Address - Phone:316-440-7000
Practice Address - Fax:316-440-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2100037175F00000X
261Q00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center