Healthcare Provider Details

I. General information

NPI: 1679853527
Provider Name (Legal Business Name): LAWRENCE PEDIATRICS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 LONGLEAF DR
LAWRENCE KS
66049-5802
US

IV. Provider business mailing address

543 LAWRENCE AVE
LAWRENCE KS
66049-4212
US

V. Phone/Fax

Practice location:
  • Phone: 785-840-8499
  • Fax:
Mailing address:
  • Phone: 785-840-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KIRSTEN E EVANS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 785-840-8499