PH: (800) 801-9772 | (316) 683-4111
© Copyright 2019: ProviDRs Care

New All Other Provider Application

To initiate application to participate as a provider in ProviDRs Care Network, please complete the below application along with attaching the applicable documents listed on the Consent and Release.  After completing the initial application, you will be contacted by our Credentialing Department to complete the credentialing process.

Fax:     (316) 683-6255
Mail:   1102 S Hillside
Wichita, KS 67211

Should you have any questions, please contact our Credentialing Department at 1 (800) 801-9772 or email us at

Please complete the below forms with the Provider’s information.