Healthcare Provider Details

I. General information

NPI: 1104918788
Provider Name (Legal Business Name): JAMIE M BOATMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

IV. Provider business mailing address

9100 W 74TH ST
SHAWNEE MISSION KS
66204-4004
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2679
  • Fax:
Mailing address:
  • Phone: 913-676-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number45924
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number92065
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: