Provider Demographics
NPI:1801014360
Name:LENZ, KATHLEEN G (APRN, BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:LENZ
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 N KEENE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6625
Mailing Address - Country:US
Mailing Address - Phone:573-875-6504
Mailing Address - Fax:573-875-7168
Practice Address - Street 1:1417 BINGHAM RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-2229
Practice Address - Country:US
Practice Address - Phone:660-882-8018
Practice Address - Fax:660-882-3188
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO116825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily