1285619767 NPI number — MS. JAN C ROWLETT RN ARNP CRNA

Table of content: MS. JAN C ROWLETT RN ARNP CRNA (NPI 1285619767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285619767 NPI number — MS. JAN C ROWLETT RN ARNP CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROWLETT
Provider First Name:
JAN
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN ARNP CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROUSSEAU
Provider Other First Name:
JAN
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN ARNP CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285619767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25097
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66225-5097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-268-4133
Provider Business Mailing Address Fax Number:
913-268-4138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 HIGHWAY 69
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT SCOTT
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66701-8885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-223-0200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  1454603052 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 54279 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 54279 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10001519005 . This is a "COMMUNITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 66048A008 . This is a "TRICARE WPS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: R76304 . This is a "PREFERRED HEALTH SYSTEMS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22140086 . This is a "BLUE CROSS BLUE SHIELD KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100247920G , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 914807532 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00407087 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 144901 . This is a "BLUE CROSS BLUE SHIELD KS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145351 . This is a "BLUE CROSS BLUE SHIELD KS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100247920J , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22140116 . This is a "BLUE CROSS BLUE SHIELD KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00042563 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00042565 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com