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General NPI Number Information
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NPI Number | 1437866084
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Entity Type | Organization
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Legal Business Name | LUMINARY BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/02/2022
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 425 N BALTIMORE AVE STE 5
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City | DERBY
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State | KS
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Zip | 67037-1625
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Country | US
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Telephone | 316-260-7900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 834
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City | DERBY
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State | KS
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Zip | 67037-0834
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Country | US
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Telephone | 316-260-7900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE XANDERS-DANLER
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Credential | PMHNP-BC
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Telephone | 316-260-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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