MEDICARE: LUREE LUSK ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	13-54154-032	KS
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	74452	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8908	OTHER	KS	PREFERRED HEALTH SYSTEMS
2	2237362	OTHER	KS	CIGNA
3	161341	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1972557981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUREE LUSK ARNP

Provider Business Mailing Address
First Line	:	934 N WATER ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-3838
Country	:	US
Telephone Number	:	316-660-7621
Fax Number	:	316-941-5075

Provider Business Practice Location Address
First Line	:	1919 N AMIDON AVE
Second Line	:	STE.100
City	:	WICHITA
State	:	KS
Zip	:	67203-2117
Country	:	US
Telephone Number	:	316-660-7540
Fax Number	:	316-660-7488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	10/17/2017

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Directions to “ LUREE LUSK ARNP” Practice Location

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