Individual
MRS. CANDACE LYNETTE LIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
507 E 16TH ST STE 1, WELLINGTON, KS 67152-2828
(620) 326-3301
(620) 326-3301
Mailing address
507 E 16TH ST STE 1, WELLINGTON, KS 67152-2828
(620) 326-3301
(620) 326-3301
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-01470
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111241001
MEDICARE
KS
01
—
12277183
CAQH
KS
01
—
1508146549
BCBS
KS
05
—
200738580
—
KS
Enumeration date
08/22/2011
Last updated
05/08/2020
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