Provider Demographics
NPI:1144967225
Name:MORGAN, LANETTE DYAN (PA-C)
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:DYAN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 W 37TH ST S
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67215-1754
Mailing Address - Country:US
Mailing Address - Phone:620-640-1967
Mailing Address - Fax:
Practice Address - Street 1:1855 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3413
Practice Address - Country:US
Practice Address - Phone:316-636-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical