Bob Born, APRN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Wichita, KS
NPI 1295775138 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1295775138
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 74595 (KS)
- Practice address
- 1421 E 2ND St N
Wichita, KS 67214-4119 - Phone
- (316) 303-0333
- Fax
- (316) 847-7093
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14-78962-091 | KS | MD | Psychiatric/Mental Health Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Sedgwick | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 14-78962-091 | KS | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 74595 | KS | Yes |
Addresses
Primary practice location
1421 E 2ND St N
Wichita, KS 67214-4119
Mailing address
1421 E 2ND St N
Wichita, KS 67214-4119
Phone (316) 303-0333
Other practice location 1
1919 N Amidon Ave
Suite 100
Wichita, KS 67203-2117
Phone (316) 660-7540
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160849 | Other | KS | BLUE CROSS BLUE SHIELD |
| 2144767 | Other | KS | CIGNA |
| 500029366 | Other | KS | RAILROAD MEDICARE |
| 14563 | Other | KS | PREFERRED HEALTH SYSTEMS |
Other providers in Wichita, KS
- Patrice Antoinette Neal Borders
- Dana Noelle Borgman
- Aimee Boriboun
- Joseph Borick
- Born Midwifery, LLC
- Kelly Born
- Abby Lee Bornholdt
- Amy L Bornholdt
- Kate Borniger
- Jesse Borosky
All providers in Wichita, KS · Psychiatric/Mental Health Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.