Provider Demographics
NPI:1659804250
Name:LANKERD, ADAM (LPN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:LANKERD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 KIMMY LN
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-2623
Mailing Address - Country:US
Mailing Address - Phone:660-723-4650
Mailing Address - Fax:
Practice Address - Street 1:1700 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-3635
Practice Address - Country:US
Practice Address - Phone:660-826-5885
Practice Address - Fax:660-826-5174
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012000715164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse