Healthcare Provider Details

I. General information

NPI: 1043843758
Provider Name (Legal Business Name): SIERRA LANAE GILMARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SIERRA BARR

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PARK ST
HAYS KS
67601-4009
US

IV. Provider business mailing address

252 E ALLEN ST
VALLEY CENTER KS
67147-2104
US

V. Phone/Fax

Practice location:
  • Phone: 785-628-4293
  • Fax:
Mailing address:
  • Phone: 316-518-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5380415101
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: