Healthcare Provider Details

I. General information

NPI: 1174561237
Provider Name (Legal Business Name): DEBORAH LOCKWOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 RENNER RD KU MEDWEST
SHAWNEE KS
66217-9414
US

IV. Provider business mailing address

2330 SHAWNEE MISSION PKWY MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312
WESTWOOD KS
66205-2005
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-8400
  • Fax: 913-588-8413
Mailing address:
  • Phone: 913-588-9000
  • Fax: 913-588-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01030
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number117957
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: