skip to Main Content
Physician Application

To initiate a credentialing or recredentialing application to participate as a provider in ProviDRs Care Network, please complete the application below, attach the required documents listed on the Consent and Release and submit it electronically. You can print and return the completed application and supporting documentation to the address or fax number on the form available online here:  Physician Application.

After submitting the completed application and required documents, please allow 45 days for the application to be processed. If additional information is needed you will be contacted by our Credentialing Department.

ProviDRs Care has transitioned from an Individual Provider Declaration of Agreement to a Group Declaration of Agreement. Please find the updated form here: Physician Group Declaration of Agreement for additional information and to complete the Group Declaration of Agreement.

Email: Credentialing@ProviDRsCare.net
Fax: (316) 683-6255
Mail: 238 N Waco
Wichita, KS 67202

Should you have any questions, please contact our Credentialing Department at 1 (800) 801-9772, option 4, option 2, or email us at Credentialing@ProviDRsCare.net.

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

Back To Top