Provider Demographics
NPI:1902542749
Name:HAWORTH HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:HAWORTH HEALTH AND WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNM, PMHNP-BC
Authorized Official - Phone:316-841-6861
Mailing Address - Street 1:535 S EMPORIA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-4534
Mailing Address - Country:US
Mailing Address - Phone:316-841-6861
Mailing Address - Fax:743-244-2912
Practice Address - Street 1:535 S EMPORIA AVE STE 103
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4534
Practice Address - Country:US
Practice Address - Phone:316-841-6861
Practice Address - Fax:743-244-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201294160AMedicaid