Provider Demographics
NPI:1801325659
Name:INTEGRATIVE HEALTH PROVIDERS LLC
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH PROVIDERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:G
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:III
Authorized Official - Credentials:NP
Authorized Official - Phone:913-353-4703
Mailing Address - Street 1:11001 HAUSER ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3708
Mailing Address - Country:US
Mailing Address - Phone:913-963-6618
Mailing Address - Fax:913-353-4031
Practice Address - Street 1:11001 HAUSER ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66210-3708
Practice Address - Country:US
Practice Address - Phone:913-963-6618
Practice Address - Fax:913-353-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 363LP0808X, 363LA2200X
KS04-23015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-77127-041OtherKANSAS STATE BOARD OF NURSING- NURSE PRACTITIONER LICENSE NUMBER