Healthcare Provider Details

I. General information

NPI: 1285695627
Provider Name (Legal Business Name): JEAN M NELSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LINCOLN ST
EMPORIA KS
66801-2449
US

IV. Provider business mailing address

1000 LINCOLN ST
EMPORIA KS
66801-2449
US

V. Phone/Fax

Practice location:
  • Phone: 620-343-2211
  • Fax: 620-342-1021
Mailing address:
  • Phone: 620-343-2211
  • Fax: 620-342-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-59020-072
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number74643
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: