=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295417046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIERHEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2023
-----------------------------------------------------
Last Update Date | 08/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1031 N KANSAS AVE
-----------------------------------------------------
City | LIBERAL
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67901-2644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-482-0746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1640 N ROOSEVELT AVE
-----------------------------------------------------
City | LIBERAL
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67901-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-339-9678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/APRN
-----------------------------------------------------
Name | LINSEY CARTER
-----------------------------------------------------
Credential | DNP, APRN, FNP-C
-----------------------------------------------------
Telephone | 620-339-9678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------