Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 79786 | KS |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R0109553 | OK |
NPI | 1003442278 |
---|---|
Provider Name | Jacob Loveless |
First Address | Wichita, KS 67214-4923 |
Second Address | Wichita, KS 67214-3788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2020 |
Last Update Date | 02/08/2021 |