Healthcare Provider Details

I. General information

NPI: 1093199051
Provider Name (Legal Business Name): JANITA-JADE COFFEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SE BLUE PKWY STE 220
LEES SUMMIT MO
64063-1043
US

IV. Provider business mailing address

10600 QUIVIRA RD STE 320
OVERLAND PARK KS
66215-2311
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-5005
  • Fax:
Mailing address:
  • Phone: 913-894-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015009931
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-76839-011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: