Provider Demographics
NPI:1144919606
Name:LAKIN, AMANDA GAIL (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:LAKIN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 11TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4419
Mailing Address - Country:US
Mailing Address - Phone:620-796-2788
Mailing Address - Fax:620-796-2789
Practice Address - Street 1:2008 11TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4419
Practice Address - Country:US
Practice Address - Phone:620-796-2788
Practice Address - Fax:620-796-2789
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82320-052363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health