Healthcare Provider Details

I. General information

NPI: 1902960990
Provider Name (Legal Business Name): KARE HENRIKSON LYCHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARE ANN HENRIKSON MD

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S CLAIRBORNE RD STE 104
OLATHE KS
66062-1744
US

IV. Provider business mailing address

407 S CLAIRBORNE RD STE 104
OLATHE KS
66062-1744
US

V. Phone/Fax

Practice location:
  • Phone: 913-468-2266
  • Fax:
Mailing address:
  • Phone: 913-468-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA061158
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006020977
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32015
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: