Provider Demographics
NPI:1174050785
Name:LEWALLEN, MEREDITH LEE (APRN, MSN, BSN)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LEE
Last Name:LEWALLEN
Suffix:
Gender:F
Credentials:APRN, MSN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:600 PARK ST # LL045MU
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4099
Mailing Address - Country:US
Mailing Address - Phone:785-628-4293
Mailing Address - Fax:785-628-4089
Practice Address - Street 1:600 PARK ST # LL045MU
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-628-4293
Practice Address - Fax:785-628-4089
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPENDINGMedicaid
KSPENDINGOtherBCBS OF KS
KSPENDINGMedicaid
KSPENDINGMedicaid