Provider Demographics
NPI:1134124795
Name:KEMMERER, JACQUELYN S (DNP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:S
Last Name:KEMMERER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:S
Other - Last Name:BRICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1004 PROGRESS DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-6345
Mailing Address - Country:US
Mailing Address - Phone:913-297-3215
Mailing Address - Fax:913-297-2732
Practice Address - Street 1:1004 PROGRESS DR STE 150
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6345
Practice Address - Country:US
Practice Address - Phone:913-297-3215
Practice Address - Fax:913-297-2732
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518297803OtherDODGE CITY WOMENS HEALTH CLINIC, INC