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General NPI Number Information
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NPI Number | 1902247067
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Entity Type | Individual
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Provider Name | JORDAN ALYSSA SEVART APRN
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Gender | Female
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 2401 GILLHAM RD
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City | KANSAS CITY
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State | MO
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Zip | 64108-4619
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Country | US
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Telephone | 816-234-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 21604 W 52ND TER
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City | SHAWNEE
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State | KS
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Zip | 66226-9700
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Country | US
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Telephone | 816-812-3880
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 5376023102
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License Number State | KS
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