Healthcare Provider Details

I. General information

NPI: 1265908909
Provider Name (Legal Business Name): LINDSEY LEE CARSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. LINDSEY LEE CONWAY

II. Dates (important events)

Enumeration Date: 10/20/2018
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N HILLSIDE ST
WICHITA KS
67214-4910
US

IV. Provider business mailing address

3201 NW SHUMWAY RD
EL DORADO KS
67042-8444
US

V. Phone/Fax

Practice location:
  • Phone: 316-390-9699
  • Fax:
Mailing address:
  • Phone: 316-390-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02144
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number15-02144
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number15-02144
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: