Provider Demographics
NPI:1063454452
Name:BOAN, JACQUELYN E (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:E
Last Name:BOAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11201 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-2502
Mailing Address - Country:US
Mailing Address - Phone:816-765-0232
Mailing Address - Fax:816-763-0734
Practice Address - Street 1:11201 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-2502
Practice Address - Country:US
Practice Address - Phone:816-765-0232
Practice Address - Fax:816-763-0734
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO086946363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology