Provider Demographics
NPI:1568466043
Name:LEIS, KURT D (ARNP)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:D
Last Name:LEIS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N KANSAS
Mailing Address - Street 2:SUITE 3049
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3199
Mailing Address - Country:US
Mailing Address - Phone:316-293-2647
Mailing Address - Fax:316-293-1863
Practice Address - Street 1:1001 N MINNEAPOLIS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3124
Practice Address - Country:US
Practice Address - Phone:316-293-2647
Practice Address - Fax:316-293-1863
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161920OtherBCBS
KS161220Medicare ID - Type Unspecified
KS161920OtherBCBS
Q11546Medicare UPIN