Provider Demographics
NPI:1417515727
Name:BURRIS, LAKYNN CLARICE (PA)
Entity Type:Individual
Prefix:
First Name:LAKYNN
Middle Name:CLARICE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAKYNN
Other - Middle Name:CLARICE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10202 W 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4377
Mailing Address - Country:US
Mailing Address - Phone:316-729-9100
Mailing Address - Fax:316-729-9185
Practice Address - Street 1:10202 W 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4377
Practice Address - Country:US
Practice Address - Phone:316-729-9100
Practice Address - Fax:316-729-9185
Is Sole Proprietor?:No
Enumeration Date:2019-06-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant