Provider Demographics
NPI:1881394500
Name:CONNER, KAYLEE LYNAE (APRN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:LYNAE
Last Name:CONNER
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 1:1300 E MEADOWLARK BLVD APT 11-204
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-9449
Mailing Address - Country:US
Mailing Address - Phone:417-291-3138
Mailing Address - Fax:
Practice Address - Street 1:100 W 16TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:KS
Practice Address - Zip Code:67045-1096
Practice Address - Country:US
Practice Address - Phone:620-583-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS82013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily