Healthcare Provider Details

I. General information

NPI: 1265798482
Provider Name (Legal Business Name): LORA LEA JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORA LEA SANDER RN

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S 7 HWY
BLUE SPRINGS MO
64014-5301
US

IV. Provider business mailing address

3201 S 7 HWY
BLUE SPRINGS MO
64014-5301
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75651
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012008582
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: