Healthcare Provider Details

I. General information

NPI: 1811278872
Provider Name (Legal Business Name): JEFFREY M WADDELL ARNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2011
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S MAIN ST
OTTAWA KS
66067-2327
US

IV. Provider business mailing address

405 S CLAIRBORNE RD STE 2
OLATHE KS
66062-1774
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-2266
  • Fax: 877-207-1146
Mailing address:
  • Phone: 913-730-3674
  • Fax: 913-768-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA132444
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75481
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: