MEDICARE: MS. STACY JERVIS FNP-BC, MED, CNRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WN0800X	Neuroscience Registered Nurse	14-127265-032	KS
2	363LF0000X	Family Nurse Practitioner	53-76375-032	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538569199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACY JERVIS FNP-BC, MED, CNRN

Provider Business Mailing Address
First Line	:	2508 EDGEMONT DR STE 2
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-3844
Country	:	US
Telephone Number	:	620-442-7120
Fax Number	:	620-442-7121

Provider Business Practice Location Address
First Line	:	2508 EDGEMONT DR STE 2
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-3844
Country	:	US
Telephone Number	:	620-442-7120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2014
Last Update Date	:	02/07/2022

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