Healthcare Provider Details

I. General information

NPI: 1700268349
Provider Name (Legal Business Name): KATHERINE ELIZABETH LYSAUGHT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY 3901 RAINBOW BLVD. 6040 DELP, MS 1020
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

KANSAS UNIVERISTY PHYSICIANS, INC. 3901 RAINBOW BLVD. 4070 DELP, MS 4017
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6005
  • Fax: 913-588-3877
Mailing address:
  • Phone: 913-588-2501
  • Fax: 913-588-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76826
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: