Provider Demographics
NPI:1093040438
Name:CONGLETON, BRITANI L (PA-C)
Entity type:Individual
Prefix:MS
First Name:BRITANI
Middle Name:L
Last Name:CONGLETON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITANI
Other - Middle Name:L
Other - Last Name:PLUMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4930 OVERLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-856-0708
Mailing Address - Fax:785-856-0709
Practice Address - Street 1:4930 OVERLAND DRIVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-856-0708
Practice Address - Fax:785-856-0709
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1501350OtherKS LICENSE NUMBER