Provider Demographics
NPI:1275038846
Name:TATUM, DONNA LEIGH (LAC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LEIGH
Last Name:TATUM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 STATE LINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3715
Mailing Address - Country:US
Mailing Address - Phone:816-265-1746
Mailing Address - Fax:
Practice Address - Street 1:8012 STATE LINE RD STE 201
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3715
Practice Address - Country:US
Practice Address - Phone:816-265-1746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23-00005171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS23-00005OtherACUPUNCTURE LICENSE NUMBER