Healthcare Provider Details

I. General information

NPI: 1255768354
Provider Name (Legal Business Name): JILL SOENEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12140 NALL AVE SUITE 100
OVERLAND PARK KS
66209-2503
US

IV. Provider business mailing address

7450 KESSLER ST STE 203
MERRIAM KS
66204-2553
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-8500
  • Fax: 913-451-1754
Mailing address:
  • Phone: 913-676-7585
  • Fax: 913-676-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2013036186
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number76152
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: