MEDICARE: KASSANDRA NICOLE JOHNS 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	363LF0000X	Family Nurse Practitioner	5382946011	KS

General Provider Information

NPI Number	:	1649037409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA NICOLE JOHNS APRN

Provider Business Mailing Address
First Line	:	17920 SUNFLOWER RD
Second Line	:
City	:	EDGERTON
State	:	KS
Zip	:	66021-9771
Country	:	US
Telephone Number	:	785-248-3088
Fax Number	:

Provider Business Practice Location Address
First Line	:	6240 W 135TH ST STE 150
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66223-4857
Country	:	US
Telephone Number	:	913-632-9500
Fax Number	:

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

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	02/28/2024

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