Provider Demographics
NPI:1770249237
Name:HEALTH ATLAST WICHITA LLC
Entity type:Organization
Organization Name:HEALTH ATLAST WICHITA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JESSIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON-COOKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:316-806-0176
Mailing Address - Street 1:10111 E 21ST ST N STE 315
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3581
Mailing Address - Country:US
Mailing Address - Phone:316-807-0835
Mailing Address - Fax:
Practice Address - Street 1:10111 E 21ST ST N STE 315
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3581
Practice Address - Country:US
Practice Address - Phone:316-807-0835
Practice Address - Fax:316-330-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty