Healthcare Provider Details

I. General information

NPI: 1134784093
Provider Name (Legal Business Name): JEANA RENEE WILCOX PHD, RN, APMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 19TH TER
KANSAS CITY MO
64108-2026
US

IV. Provider business mailing address

504 NW ASHURST PL
LEES SUMMIT MO
64081-2080
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-6010
  • Fax:
Mailing address:
  • Phone: 816-225-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number2019010660
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: