Provider Demographics
NPI:1477995678
Name:LAHITA, LAUREL A (APRN)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:LAHITA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N KANSAS AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-3346
Mailing Address - Country:US
Mailing Address - Phone:620-275-9434
Mailing Address - Fax:620-275-1448
Practice Address - Street 1:504 N KANSAS AVE
Practice Address - Street 2:STE B
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-3346
Practice Address - Country:US
Practice Address - Phone:620-604-5274
Practice Address - Fax:844-704-5288
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376030363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201076940AMedicaid