Healthcare Provider Details

I. General information

NPI: 1467366088
Provider Name (Legal Business Name): JAMIE LYNN CARLSON ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 N INDEPENDENCE ST
PARK CITY KS
67219-2260
US

IV. Provider business mailing address

6015 N INDEPENDENCE ST
PARK CITY KS
67219-2260
US

V. Phone/Fax

Practice location:
  • Phone: 316-973-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number8241531397
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: