Provider Demographics
NPI:1043548142
Name:BODYWORX HEALTH CARE SERVICES, P.A.
Entity type:Organization
Organization Name:BODYWORX HEALTH CARE SERVICES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CDE
Authorized Official - Phone:316-771-7475
Mailing Address - Street 1:4031 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3724
Mailing Address - Country:US
Mailing Address - Phone:316-771-7475
Mailing Address - Fax:316-771-7475
Practice Address - Street 1:4031 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3724
Practice Address - Country:US
Practice Address - Phone:316-771-7475
Practice Address - Fax:316-771-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP42250Medicare UPIN
KS1821196007Medicare PIN
KS160694Medicare PIN