Provider Demographics
NPI:1639403348
Name:MANLEY, MICHAEL JAMES (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MANLEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:875 S SAGEBRUSH CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7663
Mailing Address - Country:US
Mailing Address - Phone:316-806-6707
Mailing Address - Fax:316-337-5758
Practice Address - Street 1:1306 STATE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-1126
Practice Address - Country:US
Practice Address - Phone:316-775-9191
Practice Address - Fax:316-775-0348
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2023-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS5382453031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1962001Medicare UPIN