Healthcare Provider Details

I. General information

NPI: 1477995678
Provider Name (Legal Business Name): LAUREL A LAHITA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N KANSAS AVE STE B
LIBERAL KS
67901-3346
US

IV. Provider business mailing address

504 N KANSAS AVE STE B
LIBERAL KS
67901-3346
US

V. Phone/Fax

Practice location:
  • Phone: 620-604-5274
  • Fax: 844-704-5288
Mailing address:
  • Phone: 620-275-9434
  • Fax: 620-275-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5376030
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: