Provider Demographics
NPI:1043843139
Name:COAN, JILL M (APRN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:COAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 WORNALL RD STE 208
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5964
Mailing Address - Country:US
Mailing Address - Phone:816-531-0552
Mailing Address - Fax:816-756-2503
Practice Address - Street 1:4320 WORNALL RD STE 208
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5964
Practice Address - Country:US
Practice Address - Phone:816-531-0552
Practice Address - Fax:816-756-2503
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020005626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily