Healthcare Provider Details

I. General information

NPI: 1770206765
Provider Name (Legal Business Name): JORDAN ALEXANDRA CUNNINGHAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 NE GOODVIEW CIR
LEES SUMMIT MO
64064-1996
US

IV. Provider business mailing address

9100 W 74TH ST
MERRIAM KS
66204-4004
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-0000
  • Fax:
Mailing address:
  • Phone: 913-632-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025051613
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number140383
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81597102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: