Healthcare Provider Details

I. General information

NPI: 1659132272
Provider Name (Legal Business Name): KASSIE LUKASZ AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 05/23/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SW COLLEGE AVE
TOPEKA KS
66606-1684
US

IV. Provider business mailing address

3136 SE BURTON ST
TOPEKA KS
66605-2138
US

V. Phone/Fax

Practice location:
  • Phone: 785-233-9643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number83070
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number147475
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: