Provider Demographics
NPI:1093199051
Name:COFFEY, JANITA-JADE (APRN)
Entity Type:Individual
Prefix:
First Name:JANITA-JADE
Middle Name:
Last Name:COFFEY
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 1:10600 QUIVIRA RD STE 320
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2311
Mailing Address - Country:US
Mailing Address - Phone:913-894-8500
Mailing Address - Fax:
Practice Address - Street 1:10600 QUIVIRA RD STE 320
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2311
Practice Address - Country:US
Practice Address - Phone:913-894-8500
Practice Address - Fax:913-492-9025
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015009931363L00000X
KS53-76839-011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner