Individual
BOB BORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1421 E 2ND ST N, WICHITA, KS 67214-4119
(316) 303-0333
(316) 847-7093
Mailing address
1421 E 2ND ST N, WICHITA, KS 67214-4119
(316) 303-0333
(316) 847-7093
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
14-78962-091
KS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
74595
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14563
PREFERRED HEALTH SYSTEMS
KS
01
—
160849
BLUE CROSS BLUE SHIELD
KS
01
—
2144767
CIGNA
KS
01
—
500029366
RAILROAD MEDICARE
KS
Enumeration date
06/08/2006
Last updated
03/17/2018
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