Organization
INTEGRATIVE HEALTH PROVIDERS LLC
Active
Other names
Vitality Lifestyle Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
EVERETT G. BENNETT III NP (OWNER)
(913) 353-4703
Entity
Organization
Contact information
Practice address
11001 HAUSER ST, LENEXA, KS 66210-3708
(913) 963-6618
(913) 353-4031
Mailing address
11001 HAUSER ST, LENEXA, KS 66210-3708
(913) 963-6618
(913) 353-4031
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207R00000X
Internal Medicine Physician
04-23015
KS
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53-77127-041
KANSAS STATE BOARD OF NURSING- NURSE PRACTITIONER LICENSE NUMBER
KS
Enumeration date
06/06/2017
Last updated
08/08/2024
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