Healthcare Provider Details

I. General information

NPI: 1457659104
Provider Name (Legal Business Name): JANDRA G HANCOCK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 01/24/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8804 RENNER BLVD STE 200
LENEXA KS
66219
US

IV. Provider business mailing address

8804 RENNER BLVD STE 200
LENEXA KS
66219
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-8400
  • Fax: 913-599-1692
Mailing address:
  • Phone: 913-676-8400
  • Fax: 913-599-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number53-75337-061
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-75337
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: