1629136056 NPI number — MS. ANDRA BETH LUKE APRN

Table of content: MS. ANDRA BETH LUKE APRN (NPI 1629136056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629136056 NPI number — MS. ANDRA BETH LUKE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKE
Provider First Name:
ANDRA
Provider Middle Name:
BETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629136056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 SW 10TH AVE
Provider Second Line Business Mailing Address:
MEDICAL STAFF SERVICES
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66604-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-354-6241
Provider Business Mailing Address Fax Number:
785-270-4343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 SW 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66604-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-354-6440
Provider Business Practice Location Address Fax Number:
785-354-5228
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0000X , with the licence number:  2014010578 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0000X , with the licence number: 76929 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1629136056 . This is a "WEBSITE APPLICATION, NEEDED FOR WORK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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