Provider Demographics
NPI:1053919514
Name:LICHTE, KELLI (FNP-C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:LICHTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1345
Mailing Address - Country:US
Mailing Address - Phone:660-259-2216
Mailing Address - Fax:
Practice Address - Street 1:1026 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1345
Practice Address - Country:US
Practice Address - Phone:660-259-2216
Practice Address - Fax:660-259-3490
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020033399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily