Healthcare Provider Details

I. General information

NPI: 1649974486
Provider Name (Legal Business Name): LYDIA DENNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/28/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10951 LAKEVIEW AVE STE A
LENEXA KS
66219-1331
US

IV. Provider business mailing address

10951 LAKEVIEW AVE
LENEXA KS
66219-1331
US

V. Phone/Fax

Practice location:
  • Phone: 913-553-0945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5381971041
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023010663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: