Provider Demographics
NPI:1437775574
Name:IMEL, JENNIFER ANN (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:IMEL
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N FORD AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67834-3460
Mailing Address - Country:US
Mailing Address - Phone:620-826-3266
Mailing Address - Fax:
Practice Address - Street 1:101 N FORD AVE
Practice Address - Street 2:
Practice Address - City:BUCKLIN
Practice Address - State:KS
Practice Address - Zip Code:67834-3460
Practice Address - Country:US
Practice Address - Phone:620-826-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-112791163W00000X
KS53-79600-122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse