Provider Demographics
NPI:1225117468
Name:HERMES, JAYNE LOU (APRN)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:LOU
Last Name:HERMES
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 1:3343 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4917
Mailing Address - Country:US
Mailing Address - Phone:316-260-4110
Mailing Address - Fax:316-351-5731
Practice Address - Street 1:3343 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4917
Practice Address - Country:US
Practice Address - Phone:316-260-4110
Practice Address - Fax:316-351-5731
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA3538001Medicare PIN
KSQ74713Medicare UPIN