DR. LARRY DAVID MITNAUL JR. (NPI# 1659633709) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659633709 |
| Entity Type | Individual |
| Full Name | DR. LARRY DAVID MITNAUL JR. |
| Credential | M.D., M.P.H., M.S. |
| Practice Address |
1515 S Clifton Ave Ste 300 Wichita KS 67218-2953 |
| Practice Telephone | (316) 858-0550 |
| Practice Fax Number | 3168580596 |
| Mailing Telephone | (316) 858-0550 |
| Mailing Fax Number | 3168580596 |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2017-07-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
04-40194 | KS | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
1515 S CLIFTON AVE STE 300 |
| City | WICHITA |
| State | KS |
| Zip Code | 67218-2953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669671707 | Christi Lorraine Leach | Psychiatry & Neurology | 1515 S Clifton Ave Ste 300, Wichita, KS 67218-2953 | 2007-07-17 |
| 1144698903 | Alexandra Marie Landon | Physician Assistant | 1515 S Clifton Ave Ste 300, Wichita, KS 67218 | 2015-09-10 |
| 1952791428 | Denise Bishop | Social Worker | 1515 S Clifton Ave Ste 300, Wichita, KS 67218 | 2015-02-04 |
| 1942646252 | Walter Kalu Kalu | Psychiatry & Neurology | 1515 S Clifton Ave Ste 300, Wichita, KS 67218 | 2013-05-14 |
| 1255591442 | Moneeshindra Singh Mittal | Psychiatry & Neurology | 1515 S Clifton Ave Ste 300, Wichita, KS 67218 | 2008-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114544392 | Diana Ho | Optometrist | 980 Oliver Street, Wichita, KS 67218 | 2020-07-03 |
| 1134773690 | Lily Lopez | Nurse's Aide | 5107 E Kellogg Drive, Wichita, KS 67218 | 2019-08-01 |
| 1750862512 | Kelsi Wenger | Student in an Organized Health Care Education/Training Program | 5500 E Kellog Dr, Wichita, KS 67218 | 2018-08-28 |
| 1770038937 | Hair Replacement Clinic | Specialist | 1815 S Windsor, Wichita, KS 67218 | 2016-08-17 |
| 1457757346 | South Wind Women's Centter, LLC | Clinic/Center | 5701 E Kellogg Drive, Wichita, KS 67218 | 2014-11-05 |
| 1124460787 | Teri Kitchen | Social Worker | 3414 Kinkaid, Wichita, KS 67218 | 2013-07-24 |
| 1053660142 | Glenda Rodgers-lawless, Ph.d., Lcpc, Pa | Community/Behavioral Health | 4601 E Douglas, Wichita, KS 67218 | 2012-09-05 |
| 1649541848 | Stephen Rhinehart | Registered Nurse | 5500 E Kellogg Dr., Wichita, KS 67218 | 2012-01-19 |
| 1457666927 | Recovery Services Council Inc. | Point of Service | 1611 South Rutan, Wichita, KS 67218 | 2010-08-09 |
| 1043535867 | Melissa A Weinley | Respiratory Therapist, Registered | 5500 East Kellog Dr, Wichita, KS 67218 | 2010-04-05 |
| Find all providers in zip 67218 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235344433 | Mathias James Lillig | Psychiatry & Neurology | 1001 N Minneapolis St, Wichita, KS 67214-3127 | 2007-05-11 |
| 1265416499 | Kimberly J Pankow | Psychiatry & Neurology | 5500 E Kellogg Dr, Bh, Wichita, KS 67218-1607 | 2005-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760652531 | Robert Seth Gordon | Psychiatry & Neurology | 611 S Kansas Ave Ste 101, Topeka, KS 66603 | 2008-03-07 |
| 1902945934 | Mwendalubi Yasa | Psychiatry & Neurology | 1901 East First Street, Prairie View, Newton, KS 67114-0467 | 2007-02-06 |
| 1871639799 | Kansas University Physicians Inc | Psychiatry & Neurology | 1088 Delp Pavilion, Mail Stop 4015 3901 Rainbow Blvd, Kansas City, KS 66160 | 2007-01-29 |
| 1306996434 | Poonam Khanna | Psychiatry & Neurology | 14221 Metcalf Ave, Suite 123, Overland Park, KS 66223-3344 | 2007-01-11 |
| 1225067655 | M David Brown | Psychiatry & Neurology | 8300 College Blvd Ste 320, Overland Park, KS 66210-2814 | 2006-06-30 |
| 1629510417 | Wexler Family Psychiatry | Psychiatry & Neurology | 4203 Booth St, Kansas City, KS 66103-3116 | 2016-11-09 |
| 1548680507 | Caitlin Mellencamp Winder | Psychiatry & Neurology | 8000 W 127th St, Overland Park, KS 66213-2714 | 2014-04-17 |
| 1821346495 | Stacey Allison Laird | Psychiatry & Neurology | 4121 W 83rd St, Suite 204, Prairie Village, KS 66208-5472 | 2012-08-29 |
| 1851646285 | Anthony Anunwa Md Pa | Psychiatry & Neurology | 1600 N Lorraine St, Hutchinson, KS 67501-5670 | 2012-07-23 |
| 1164784963 | Daniel J Tseng | Psychiatry & Neurology | 650 Huebner Rd, Fort Riley, KS 66442 | 2012-06-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.