Healthcare Provider Details

I. General information

NPI: 1710370697
Provider Name (Legal Business Name): JENNIFER LYNN ANTRIM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 SW 6TH AVE STE 220
TOPEKA KS
66615-1004
US

IV. Provider business mailing address

3405 NW HUNTERS RIDGE TERRACE SUITE 100
TOPEKA KS
66618-2510
US

V. Phone/Fax

Practice location:
  • Phone: 785-232-0444
  • Fax: 785-232-1562
Mailing address:
  • Phone: 785-246-3733
  • Fax: 785-246-3406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76747-092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: