Basic Information
| Provider Information | |||||||||
| NPI: | 1891281655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNSELL | ||||||||
| FirstName: | KEIKO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 SW HUNTOON ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858618800 | ||||||||
| FaxNumber: | 7854785991 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 SW HUNTOON ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858618800 | ||||||||
| FaxNumber: | 7854785991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2018 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 78143 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 201204450B | 05 | KS | MEDICAID |