PH: (800) 801-9772 | (316) 683-4111
© Copyright 2020: ProviDRs Care

New Physician Application

To initiate a credentialing application to participate as a provider in ProviDRs Care Network, please complete the application below and attach the required documents listed on the Consent and Release. After submitting the completed application and required documents, please allow 30 days for the application to be processed. If additional information is needed you will be contacted by our Credentialing Department.

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, option 4, option 2, or email us at

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