Provider Demographics
NPI:1134375280
Name:MILEHAM, SUSAN (ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MILEHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:PROVORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1660 N TYLER RD STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4918
Mailing Address - Country:US
Mailing Address - Phone:316-779-3873
Mailing Address - Fax:316-425-5558
Practice Address - Street 1:1660 N TYLER RD STE A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4918
Practice Address - Country:US
Practice Address - Phone:316-779-3873
Practice Address - Fax:316-425-5558
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-46228-041363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health