Provider Demographics
NPI:1760088900
Name:LKN WEIGHT LOSS AND WELLNESS LLC
Entity Type:Organization
Organization Name:LKN WEIGHT LOSS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLICHER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:704-964-6250
Mailing Address - Street 1:20808 N MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8496
Mailing Address - Country:US
Mailing Address - Phone:704-964-6250
Mailing Address - Fax:704-610-2500
Practice Address - Street 1:20808 N MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8496
Practice Address - Country:US
Practice Address - Phone:704-964-6250
Practice Address - Fax:704-610-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073077293Medicaid