Provider Demographics
NPI:1285894709
Name:RUNYAN, EMILY RUTH
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RUTH
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:RUTH
Other - Last Name:BINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8451 E PAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5420
Mailing Address - Country:US
Mailing Address - Phone:316-618-0035
Mailing Address - Fax:316-633-4468
Practice Address - Street 1:8451 E PAWNEE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5420
Practice Address - Country:US
Practice Address - Phone:166-180-0353
Practice Address - Fax:316-633-4468
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-92793-092390200000X
KS46212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004029160008Medicaid