Healthcare Provider Details

I. General information

NPI: 1275781155
Provider Name (Legal Business Name): LINDSEY RAGLAND CLANCEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY OLOMON RAGLAND M.D.

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

IV. Provider business mailing address

10540 MARTY ST STE 100
OVERLAND PARK KS
66212-2551
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2000
  • Fax:
Mailing address:
  • Phone: 913-660-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036123808
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-37157
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: