MEDICARE: MS. JEANNE LYNN PEARSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	53-75605	KS

General Provider Information

NPI Number	:	1619235819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE LYNN PEARSON APRN

Provider Business Mailing Address
First Line	:	4013 N RIDGE RD
Second Line	:	SUITE 110
City	:	WICHITA
State	:	KS
Zip	:	67205-8857
Country	:	US
Telephone Number	:	316-722-1333
Fax Number	:	316-722-3058

Provider Business Practice Location Address
First Line	:	4013 N RIDGE RD
Second Line	:	SUITE 110
City	:	WICHITA
State	:	KS
Zip	:	67205-8857
Country	:	US
Telephone Number	:	316-722-1333
Fax Number	:	316-722-3058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	05/02/2012

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