Healthcare Provider Details

I. General information

NPI: 1659953792
Provider Name (Legal Business Name): JEFFREY NOWLIN PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 CLAY EDWARDS DR STE 650
KANSAS CITY MO
64116-3279
US

IV. Provider business mailing address

2790 CLAY EDWARDS DR STE 650
KANSAS CITY MO
64116-3279
US

V. Phone/Fax

Practice location:
  • Phone: 816-459-7500
  • Fax: 816-207-3768
Mailing address:
  • Phone: 816-459-7500
  • Fax: 816-207-3768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2025044489
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-03249
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2695
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA218626
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: