Healthcare Provider Details

I. General information

NPI: 1629675749
Provider Name (Legal Business Name): JANA LEE JOHNSTON CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 04/30/2024
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VIEW HIGH DR
KANSAS CITY MO
64134-2343
US

IV. Provider business mailing address

1201 SW CREEKSIDE DR
LEES SUMMIT MO
64081-3254
US

V. Phone/Fax

Practice location:
  • Phone: 913-214-8979
  • Fax: 913-357-6288
Mailing address:
  • Phone: 816-809-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number20090025
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: