Provider Demographics
NPI:1144749672
Name:KIMM, JASON EDWARD (FNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:KIMM
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-3544
Mailing Address - Country:US
Mailing Address - Phone:1913-220-8138
Mailing Address - Fax:
Practice Address - Street 1:800 W FRONTIER LN
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7216
Practice Address - Country:US
Practice Address - Phone:877-397-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS155240363LF0000X
KS53-77844-072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily