Healthcare Provider Details

I. General information

NPI: 1295649754
Provider Name (Legal Business Name): LISA D TIMMONS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N WILBUR LN
WICHITA KS
67212-3026
US

IV. Provider business mailing address

1030 N WILBUR LN
WICHITA KS
67212-3026
US

V. Phone/Fax

Practice location:
  • Phone: 316-973-1362
  • Fax: 316-973-1360
Mailing address:
  • Phone: 316-973-1362
  • Fax: 316-973-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number13-101373-082
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: