NPI 1245101260 · live from the CMS NPI Registry
Medra LLC
Dermatology, Procedural Dermatology in Carbondale, KS. National Provider Identifier 1245101260, active.
NPI record
| NPI | 1245101260 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dermatology, Procedural Dermatology 207NS0135X |
| Practice location | 3995 W 125th St, Carbondale, KS 66414 |
| Practice phone | 785-364-7245 |
| Enumerated | September 15, 2025 |
| Last updated | September 15, 2025 |
| Authorized official | Morgan Thompson, Nurse Practitioner, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse, General Practice | 163WG0000X | — |
| Nurse Practitioner, Family | 363LF0000X | — |
| Dermatology, Procedural Dermatology primary | 207NS0135X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.