Individual
MR. KEVIN E HARTLEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
940 N WACO AVE, WICHITA, KS 67203-3947
(316) 660-7550
(316) 383-8241
Mailing address
635 N MAIN ST, WICHITA, KS 67203-3602
(316) 660-7600
(316) 383-7925
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1835
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
389922
BLUE CROSS BLUE SHIELD
KS
01
—
4217
PREFERRED PLUS OF KANSAS
KS
Enumeration date
05/12/2006
Last updated
07/08/2007
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