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General NPI Number Information
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NPI Number | 1245101260
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Entity Type | Organization
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Legal Business Name | MEDRA LLC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 3995 W 125TH ST
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City | CARBONDALE
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State | KS
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Zip | 66414-9250
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Country | US
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Telephone | 785-364-7245
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Fax |
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Provider Business Mailing Address
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Address Line | 3995 W 125TH ST
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City | CARBONDALE
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State | KS
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Zip | 66414-9250
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Country | US
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Telephone | 785-364-7245
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER, OWNER
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Name | MRS. MORGAN ELIZABETH THOMPSON
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Credential | NP-C
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Telephone | 785-364-7245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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