Healthcare Provider Details

I. General information

NPI: 1225117468
Provider Name (Legal Business Name): JAYNE LOU HERMES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 W CENTRAL AVE
WICHITA KS
67203-4917
US

IV. Provider business mailing address

3343 W CENTRAL AVE
WICHITA KS
67203-4917
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-4110
  • Fax: 316-351-5731
Mailing address:
  • Phone: 316-260-4110
  • Fax: 316-351-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number45939
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: