Individual
NIKOLAS D FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1911 N WEBB RD, WICHITA, KS 67206-3405
(316) 682-7546
(316) 682-7554
Mailing address
1911 N WEBB RD, WICHITA, KS 67206-3405
(316) 682-7546
(316) 682-7554
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
15-01151
KS
363AM0700X
Medical Physician Assistant
Primary
15-01151
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200423310B
—
KS
01
—
P00606972
PALMETTO (RRMC)
KS
Enumeration date
08/29/2006
Last updated
09/15/2014
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