Healthcare Provider Details

I. General information

NPI: 1861258766
Provider Name (Legal Business Name): JENNIFER THIBAULT DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11626 S WATER ST
OLATHE KS
66061-8784
US

IV. Provider business mailing address

11626 S WATER ST
OLATHE KS
66061-8784
US

V. Phone/Fax

Practice location:
  • Phone: 785-341-5984
  • Fax:
Mailing address:
  • Phone: 785-341-5984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5383530081
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1386721081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: