Healthcare Provider Details

I. General information

NPI: 1013499235
Provider Name (Legal Business Name): JENELLE PEARSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 SOUTHWEST BLVD
KANSAS CITY KS
66103-2150
US

IV. Provider business mailing address

4600 COLLEGE BLVD STE 103
OVERLAND PARK KS
66211-1606
US

V. Phone/Fax

Practice location:
  • Phone: 913-722-3100
  • Fax: 913-722-2542
Mailing address:
  • Phone: 913-215-5008
  • Fax: 913-297-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number000000000
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: