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General NPI Number Information
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NPI Number | 1366949976
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Entity Type | Individual
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Provider Name | JORDAN CALABRESE
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Gender | Male
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 20333 W 151ST ST
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City | OLATHE
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State | KS
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Zip | 66061-5350
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Country | US
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Telephone | 913-791-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 20333 W 151ST ST
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City | OLATHE
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State | KS
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Zip | 66061-7211
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Country | US
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Telephone | 913-791-4200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 05-46672
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License Number State | KS
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