Provider Demographics
NPI:1083700934
Name:FREEMAN, JANETTA K (RNC, PAC)
Entity Type:Individual
Prefix:
First Name:JANETTA
Middle Name:K
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RNC, PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2135
Mailing Address - Country:US
Mailing Address - Phone:620-356-1261
Mailing Address - Fax:
Practice Address - Street 1:505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2135
Practice Address - Country:US
Practice Address - Phone:620-356-1261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500649363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100340610BMedicaid
KS100340610BMedicaid
KSS72191Medicare UPIN