Basic Information
| Provider Information | |||||||||
| NPI: | 1801268404 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MH HEALTH OF KANSAS, PA | ||||||||
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| OtherOrganizationName: | MH HEALTH OF KANSAS AT OLATHE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5 | ||||||||
| Address2: | |||||||||
| City: | WINOOSKI | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054040005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028570400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1225 S HAMILTON CIR | ||||||||
| Address2: | C/O OLATHE EMPLOYEE HEALTH CENTER | ||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660615372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139716992 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2015 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | CARLSON | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8028570400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MH HEALTH OF KANSAS, PA | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.