Healthcare Provider Details

I. General information

NPI: 1730092594
Provider Name (Legal Business Name): LINDSAY RAE HAUCK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

IV. Provider business mailing address

600 SW TRAILPARK CIR
LEES SUMMIT MO
64081-2241
US

V. Phone/Fax

Practice location:
  • Phone: 816-698-8165
  • Fax:
Mailing address:
  • Phone: 816-207-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2026004024
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: