Provider Demographics
NPI:1801991237
Name:PSYCHIATRIC PRACTIQUE PA
Entity type:Organization
Organization Name:PSYCHIATRIC PRACTIQUE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINIA
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:CAROLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-696-9908
Mailing Address - Street 1:PO BOX 26601
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-6601
Mailing Address - Country:US
Mailing Address - Phone:913-696-9908
Mailing Address - Fax:913-341-8125
Practice Address - Street 1:8645 COLLEGE BLVD
Practice Address - Street 2:STE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1835
Practice Address - Country:US
Practice Address - Phone:913-696-9908
Practice Address - Fax:913-341-8125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20030079922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS35298015OtherBCBS OF KANSAS CITY
KS35298015OtherBCBS OF KANSAS CITY