Provider Demographics
NPI:1316589641
Name:LUST, KATHLEEN E
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:E
Last Name:LUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:KS
Mailing Address - Zip Code:66535
Mailing Address - Country:US
Mailing Address - Phone:785-844-2987
Mailing Address - Fax:
Practice Address - Street 1:3420 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:KS
Practice Address - Zip Code:66535
Practice Address - Country:US
Practice Address - Phone:785-844-2987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider