Basic Information
| Provider Information | |||||||||
| NPI: | 1669016424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACKERSON | ||||||||
| FirstName: | LINDSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 BLUE PKWY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641302807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169235800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3801 BLUE PKWY | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641302807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8169235800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2019 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 2019007530 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 2019007530 | 01 | MO | STATE LICENSE | OTHER |