Healthcare Provider Details

I. General information

NPI: 1285619767
Provider Name (Legal Business Name): JAN C ROWLETT RN ARNP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAN C ROUSSEAU RN ARNP CRNA

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 HIGHWAY 69
FORT SCOTT KS
66701-8885
US

IV. Provider business mailing address

PO BOX 25097
OVERLAND PARK KS
66225-5097
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-0200
  • Fax:
Mailing address:
  • Phone: 913-268-4133
  • Fax: 913-268-4138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1454603052
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number54279
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54279
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: