Provider Demographics
NPI:1407140791
Name:NIVENS, JESSICA LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:NIVENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1844
Mailing Address - Country:US
Mailing Address - Phone:913-205-7778
Mailing Address - Fax:
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 5000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-756-5900
Practice Address - Fax:816-756-5457
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-108962-041163WM0705X, 163WX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX1100XNursing Service ProvidersRegistered NurseOphthalmic
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical