MEDICARE: ANDREA CONSTANCE JASDANWALA FNP-C

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	363LF0000X	Family Nurse Practitioner	2016035602	MO
2	363LF0000X	Family Nurse Practitioner	95030255	CA

General Provider Information

NPI Number	:	1619405602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CONSTANCE JASDANWALA FNP-C

Provider Business Mailing Address
First Line	:	7505 E 87TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3917
Country	:	US
Telephone Number	:	573-201-0356
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 E 87TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3917
Country	:	US
Telephone Number	:	573-201-0356
Fax Number	:

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

Provider Enumeration Date	:	06/02/2017
Last Update Date	:	12/30/2025

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