Healthcare Provider Details

I. General information

NPI: 1053742643
Provider Name (Legal Business Name): KANSAS APRN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17985 S LONE ELM RD
OLATHE KS
66062-9253
US

IV. Provider business mailing address

17985 S LONE ELM RD
OLATHE KS
66062-9253
US

V. Phone/Fax

Practice location:
  • Phone: 816-500-0487
  • Fax:
Mailing address:
  • Phone: 816-500-0487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13-87373-111
License Number StateKS

VIII. Authorized Official

Name: LANCE A VICKERY
Title or Position: OWNER
Credential: APRN
Phone: 816-500-0487