Provider Demographics
NPI:1124165485
Name:KUNTZ, GORDON DAVID (ARNP CS)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:DAVID
Last Name:KUNTZ
Suffix:
Gender:M
Credentials:ARNP CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E 7TH
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-628-2871
Mailing Address - Fax:785-628-0426
Practice Address - Street 1:208 E 7TH
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-628-2871
Practice Address - Fax:785-628-0426
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13582171111163W00000X
KS74162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100249170BMedicaid
KS100249170BMedicaid
35202Medicare ID - Type Unspecified