Healthcare Provider Details

I. General information

NPI: 1073478616
Provider Name (Legal Business Name): LAUREN NICOLE PROKOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5827 SW 47TH ST
TOPEKA KS
66610-1204
US

IV. Provider business mailing address

5827 SW 47TH ST
TOPEKA KS
66610-1204
US

V. Phone/Fax

Practice location:
  • Phone: 785-230-4856
  • Fax:
Mailing address:
  • Phone: 785-230-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: