Provider Demographics
NPI:1912660028
Name:KANSAS PSYCHIATRIC AND WELLNESS SERVICES
Entity Type:Organization
Organization Name:KANSAS PSYCHIATRIC AND WELLNESS SERVICES
Other - Org Name:KPAWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-691-8504
Mailing Address - Street 1:205 S 4TH ST STE B12
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6166
Mailing Address - Country:US
Mailing Address - Phone:316-691-8504
Mailing Address - Fax:949-863-8565
Practice Address - Street 1:205 S 4TH ST STE B12
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6166
Practice Address - Country:US
Practice Address - Phone:316-691-8504
Practice Address - Fax:949-863-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-75194OtherKS LICENSE