Provider Demographics
NPI:1114289840
Name:JENNINGS, SALLY A (APRN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:JENNINGS
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 1:11600 COLLEGE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2786
Mailing Address - Country:US
Mailing Address - Phone:913-310-0225
Mailing Address - Fax:913-310-0565
Practice Address - Street 1:11600 COLLEGE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2786
Practice Address - Country:US
Practice Address - Phone:913-310-0225
Practice Address - Fax:913-310-0565
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13103396102163W00000X
KS75698363L00000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200879040AMedicaid