=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336744671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAN HUGHEY RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2020
-----------------------------------------------------
Last Update Date | 12/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25201 E 78 HIGHWAY
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-796-7307
-----------------------------------------------------
Fax | 816-796-7305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2805 SW SADDLEWOOD DR
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64081-2597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-804-1852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WX0106X
-----------------------------------------------------
Taxonomy Name | Occupational Health Registered Nurse
-----------------------------------------------------
License Number | 133543
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------