Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2015002153 | MO |
N | 363L00000X | Nurse Practitioner | TEMPAPRN0102 | GA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 53-76667-062 | KS |
N | 363LG0600X | Nurse Practitioner - Gerontology | 53-76667-062 | KS |
NPI | 1083003552 |
---|---|
Provider Name | Jerilyn Freeman |
First Address | Kansas City, MO 64121-9672 |
Second Address | Liberty, MO 64068-9625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2015 |
Last Update Date | 25/01/2021 |