Provider Demographics
NPI:1619780798
Name:WILSON, LAUREN WHITNEY (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:WHITNEY
Last Name:WILSON
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 1:12816 W 88TH CIR APT 97
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3559
Mailing Address - Country:US
Mailing Address - Phone:417-619-1832
Mailing Address - Fax:
Practice Address - Street 1:12816 W 88TH CIR APT 97
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3559
Practice Address - Country:US
Practice Address - Phone:417-619-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant