Healthcare Provider Details

I. General information

NPI: 1558077503
Provider Name (Legal Business Name): WELLKC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6022 MARION ST
SHAWNEE KS
66218-9254
US

IV. Provider business mailing address

6022 MARION ST
SHAWNEE KS
66218-9254
US

V. Phone/Fax

Practice location:
  • Phone: 913-513-2166
  • Fax: 913-218-3321
Mailing address:
  • Phone: 913-513-2166
  • Fax: 913-218-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACLYN BROOKE WHITLOCK
Title or Position: APRN/OWNER
Credential: APRN
Phone: 913-513-2166