Healthcare Provider Details

I. General information

NPI: 1316813116
Provider Name (Legal Business Name): JACHELLE LASHANNON POWELL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11729 ROE AVE
LEAWOOD KS
66211-2605
US

IV. Provider business mailing address

11729 ROE AVE
LEAWOOD KS
66211-2605
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-8404
  • Fax: 913-696-9895
Mailing address:
  • Phone: 913-345-8404
  • Fax: 913-696-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5386165061
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2023041152
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: