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Organization
PRAIRIE STAR FAMILY PRACTICE, P.A.
Active
Organization
PRAIRIE STAR FAMILY PRACTICE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BRULL M.D. (OWNER/PRESIDENT)
(785) 434-2622
Entity
Organization
Contact information
Practice address
1210 N. WASHINGTON, CLINIC B, PLAINVILLE, KS 67663-1632
(785) 434-2622
(785) 434-2577
Mailing address
1210 N. WASHINGTON, CLINIC B, P.O. BOX 407, PLAINVILLE, KS 67663-0407
(785) 434-2622
(785) 434-2577
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-28262
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100376880C
—
KS
01
—
101898
BC/BS INDIVIDUAL
KS
01
—
110760
BC/BS GROUP
KS
01
—
662541
FIRSTGUARD #
KS
Enumeration date
08/16/2006
Last updated
06/15/2010
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