Healthcare Provider Details

I. General information

NPI: 1134070246
Provider Name (Legal Business Name): KAITLYN ELIZABETH JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13351 S ARAPAHO DR
OLATHE KS
66062-1520
US

IV. Provider business mailing address

13351 S ARAPAHO DR
OLATHE KS
66062-1520
US

V. Phone/Fax

Practice location:
  • Phone: 913-353-3000
  • Fax:
Mailing address:
  • Phone: 913-353-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-85298-012
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: