Healthcare Provider Details

I. General information

NPI: 1861122483
Provider Name (Legal Business Name): RACHEL ANN JAMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PETER PAN RD
INDEPENDENCE KS
67301-7301
US

IV. Provider business mailing address

818 N EMPORIA ST STE 403
WICHITA KS
67214-3728
US

V. Phone/Fax

Practice location:
  • Phone: 620-331-4099
  • Fax: 620-331-0447
Mailing address:
  • Phone: 316-262-4467
  • Fax: 316-262-3762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number84173
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-89624-071
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: