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

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.

All Physician Assistants and Advanced Practice Registered Nurses are also required to complete the collaborative practice agreement. The collaborative practice agreement can be found on the provider homepage located under forms. Completed collaborative practice agreements can be sent to ProviDRs Care via fax, mail, or email.

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.