Healthcare Provider Details

I. General information

NPI: 1912673559
Provider Name (Legal Business Name): LINDSEY LEE JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W MAIN ST
LOGAN KS
67646-9764
US

IV. Provider business mailing address

PO BOX 174
LOGAN KS
67646-0174
US

V. Phone/Fax

Practice location:
  • Phone: 785-689-7464
  • Fax: 785-689-7469
Mailing address:
  • Phone: 785-689-7464
  • Fax: 785-689-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-80480-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: