Healthcare Provider Details

I. General information

NPI: 1467340083
Provider Name (Legal Business Name): NATHAN PURDUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 MASSACHUSETTS ST
LAWRENCE KS
66044-3431
US

IV. Provider business mailing address

1307 MASSACHUSETTS ST
LAWRENCE KS
66044-3431
US

V. Phone/Fax

Practice location:
  • Phone: 785-424-7770
  • Fax: 833-527-8323
Mailing address:
  • Phone: 785-424-7770
  • Fax: 833-527-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number03357
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: