Healthcare Provider Details

I. General information

NPI: 1073236212
Provider Name (Legal Business Name): GABRIELLE JORDAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20375 W 151ST ST
OLATHE KS
66061-5306
US

IV. Provider business mailing address

20375 W 151ST ST
OLATHE KS
66061-5306
US

V. Phone/Fax

Practice location:
  • Phone: 913-355-8262
  • Fax:
Mailing address:
  • Phone: 913-355-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022040687
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81795-062
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2018001732
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: