Healthcare Provider Details

I. General information

NPI: 1437775574
Provider Name (Legal Business Name): JENNIFER ANN IMEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 03/19/2025
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MAIN STREET
MINNEOLA KS
67865
US

IV. Provider business mailing address

222 MAIN STREET
MINNEOLA KS
67865
US

V. Phone/Fax

Practice location:
  • Phone: 620-885-4202
  • Fax: 620-885-4205
Mailing address:
  • Phone: 620-885-4202
  • Fax: 620-885-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number14-112791
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79600-122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: