Provider Demographics
NPI:1891882163
Name:LANCASTER, DEBRA J (APRN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 MAIN ST
Mailing Address - Street 2:PO BOX 127
Mailing Address - City:BLOOM
Mailing Address - State:KS
Mailing Address - Zip Code:67865-8511
Mailing Address - Country:US
Mailing Address - Phone:620-885-4202
Mailing Address - Fax:620-885-4805
Practice Address - Street 1:101 N FORD AVE
Practice Address - Street 2:
Practice Address - City:BUCKLIN
Practice Address - State:KS
Practice Address - Zip Code:67834-3460
Practice Address - Country:US
Practice Address - Phone:620-826-3266
Practice Address - Fax:620-826-3527
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44276363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100250230CMedicaid
S78766Medicare UPIN
KS100250230CMedicaid