Individual
BRYAN CHRISTOPHER KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1947 N FOUNDERS CIR, WICHITA, KS 67206-3548
(316) 613-4930
(316) 689-9769
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9667
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54960
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719339
MEDICARE PTAN
—
05
—
100381780H
—
KS
01
—
200089000A
OK MEDICAID
OK
Enumeration date
01/25/2006
Last updated
10/21/2014
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