Provider Demographics
NPI:1669481826
Name:TROUTMAN, BETTY (DO)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:TROUTMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 E 21ST ST N
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3508
Mailing Address - Country:US
Mailing Address - Phone:316-833-4729
Mailing Address - Fax:
Practice Address - Street 1:10111 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3508
Practice Address - Country:US
Practice Address - Phone:316-833-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1384OtherPHS
KS16873OtherCOVENTRY
KS12149482OtherMULTIPLAN
KS024376Medicare ID - Type Unspecified
KS024376OtherBCBS
KS100454OtherHPK
E59086Medicare UPIN