Provider Demographics
NPI:1134484439
Name:JANSEN, KAITLYN LOUISE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LOUISE
Last Name:JANSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:LOUISE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5310 S 165TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-6210
Mailing Address - Country:US
Mailing Address - Phone:319-239-8384
Mailing Address - Fax:
Practice Address - Street 1:4101 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1850
Practice Address - Country:US
Practice Address - Phone:402-346-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-102039183500000X
MO2012037982183500000X
IA21668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist