PH: (800) 801-9772 | (316) 683-4111
© Copyright 2021: ProviDRs Care

PA Application

To initiate a credentialing or recredentialing 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. ProviDRs Care has transitioned from an Individual Provider Declaration of Agreement to a Group Declaration of Agreement. Please refer to the Providers Page found here: for additional information and to complete the Group Declaration of Agreement. 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: 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

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