NPI 1417867789 · live from the CMS NPI Registry
Advanced Practice Dermatology LLC
Nurse Practitioner in Liberal, KS. National Provider Identifier 1417867789, active.
NPI record
| NPI | 1417867789 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner 363L00000X |
| Practice location | 1031 N Kansas Ave, Liberal, KS 67901 |
| Practice phone | 620-655-4302 |
| Mailing address | 240 Cactus Ln, Turpin, OK 73950 |
| Enumerated | September 9, 2026 |
| Last updated | September 9, 2026 |
| Authorized official | Jennifer Ebersole, Arnp |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner primary | 363L00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.