Healthcare Provider Details

I. General information

NPI: 1922562784
Provider Name (Legal Business Name): BRIAN MATTHEW LEDUC APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 10TH AVE
TOPEKA KS
66604-1301
US

IV. Provider business mailing address

1500 SW 10TH AVE
TOPEKA KS
66604-1301
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-5242
  • Fax:
Mailing address:
  • Phone: 785-354-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13-0042918
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA193791
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79719
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2020030796
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: