Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 156505 | KS |
NPI | 1033608625 |
---|---|
Provider Name | Miss Jennifer Linn Johnk |
First Address | Roeland Park, KS 66205-2226 |
Second Address | Kansas City, KS 66160-8501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2018 |
Last Update Date | 09/05/2018 |