Provider Demographics
NPI:1154050003
Name:LEHRMAN, MAKENNA JO
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:JO
Last Name:LEHRMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1916
Mailing Address - Country:US
Mailing Address - Phone:785-301-2250
Mailing Address - Fax:785-301-2270
Practice Address - Street 1:3012 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1916
Practice Address - Country:US
Practice Address - Phone:785-301-2250
Practice Address - Fax:785-301-2270
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-026932086S0122X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical