Individual
DR. CHARLES A GAYNOR
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
1919 N AMIDON AVE, STE. 130, WICHITA, KS 67203-2117
(316) 660-7675
(316) 832-1571
Mailing address
635 N MAIN ST, WICHITA, KS 67203-3602
(316) 660-7600
(316) 383-7925
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0405
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022101
BLUE CROSS
KS
01
—
2144774
CIGNA
KS
01
—
4205
PREFERRED HEALTH SYSTEMS
KS
01
—
PV115577
AMERICAN PSYCH SYSTEMS
KS
Enumeration date
06/02/2006
Last updated
07/08/2007
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