Provider Demographics
NPI:1295809192
Name:MCCULLOUGH, FINNIAN CHRISTOPHER (ARNP, MS, BC)
Entity type:Individual
Prefix:MR
First Name:FINNIAN
Middle Name:CHRISTOPHER
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:ARNP, MS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1396
Mailing Address - Country:US
Mailing Address - Phone:785-843-9192
Mailing Address - Fax:785-843-2219
Practice Address - Street 1:200 MAINE ST STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-843-9192
Practice Address - Fax:785-843-2219
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74550364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1295809192Medicaid
KS21643017OtherBCBS OF KANSAS CITY
KS161400Medicare PIN