Provider Demographics
NPI:1376652404
Name:KISTLER, JANA C (ARNP -C)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:C
Last Name:KISTLER
Suffix:
Gender:F
Credentials:ARNP -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 NW 62ND TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2411
Mailing Address - Country:US
Mailing Address - Phone:816-584-8884
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:SUITE G600
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-65120-081163W00000X
MO095648163W00000X
KS45753363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1376652404Medicaid
KS200358780AMedicaid
KS1103300023Medicare PIN
Q59170Medicare UPIN
KS038E281BMedicare PIN