Provider Demographics
NPI:1376278648
Name:DR FUNTIMES MENTAL WELLNESS LLC
Entity Type:Organization
Organization Name:DR FUNTIMES MENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:913-205-2677
Mailing Address - Street 1:833 SW LEMANS LN # 126
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4618
Mailing Address - Country:US
Mailing Address - Phone:913-205-2677
Mailing Address - Fax:
Practice Address - Street 1:7050 W 107TH ST STE 10
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1921
Practice Address - Country:US
Practice Address - Phone:913-205-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty