Provider Demographics
NPI:1518035708
Name:LEWIS, JAN N (FNP-BC, AOCN)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:N
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-BC, AOCN
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:N
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9212 N TRACY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2383
Mailing Address - Country:US
Mailing Address - Phone:816-830-9338
Mailing Address - Fax:
Practice Address - Street 1:9212 N TRACY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2383
Practice Address - Country:US
Practice Address - Phone:816-830-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000144267363LF0000X, 163W00000X
KS45195363LF0000X
KS13-52189-012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P41045Medicare UPIN
MOP00975483Medicare PIN
MOMA3347024Medicare PIN
KS100405710EMedicaid
MO1518035708Medicaid