Active NPI
Kelsie Lynn Diskin, DDS
- General Practice Dentistry
- Andover, KS
National Provider Identifier
1467020362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 61874
- Practice address
- 360 Heritage Way
Suite 100
Andover, KS 67002 - Phone
- (316) 733-4886
- NPI assigned
- Jun 16, 2021
- Last updated
- Mar 27, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61874 | KS | |
| General Practice Dentistry | 1223G0001X | 61874 | KS | Primary |
Addresses
Primary practice location
360 Heritage Way
Suite 100
Andover, KS 67002
Mailing address
360 Heritage Way
Suite 100
Andover, KS 67002
Phone (316) 733-4886
Other names 1
- Dr. Kelsie Lynn Jack
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61874 | KS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aaron a Huslig DDS PA | Dentist | Past | Accepting new patients |
| Sunflower Smiles PA | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Hillsboro, KS
- NPI 1669990446
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743033600000",
"number": "1467020362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 HERITAGE WAY",
"address_2": "SUITE 100",
"city": "ANDOVER",
"state": "KS",
"postal_code": "67002",
"telephone_number": "316-733-4886",
"fax_number": "316-733-8476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 HERITAGE WAY",
"address_2": "SUITE 100",
"city": "ANDOVER",
"state": "KS",
"postal_code": "67002",
"telephone_number": "316-733-4886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISKIN",
"first_name": "KELSIE",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-16",
"last_updated": "2025-03-27",
"certification_date": "2025-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KS",
"license": "61874",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KS",
"license": "61874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELSIE",
"last_name": "JACK",
"middle_name": "LYNN",
"prefix": "DR.",
"credential": "DDS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Andover, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.