Provider Demographics
NPI:1205597572
Name:HYSON, CATHY A
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:HYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 W 11TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1934
Mailing Address - Country:US
Mailing Address - Phone:316-619-2383
Mailing Address - Fax:
Practice Address - Street 1:5102 W 11TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1934
Practice Address - Country:US
Practice Address - Phone:316-619-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider