Provider Demographics
NPI:1578538393
Name:OWEN, JOLEYN MAE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JOLEYN
Middle Name:MAE
Last Name:OWEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4039 NW VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:KS
Mailing Address - Zip Code:66539-9472
Mailing Address - Country:US
Mailing Address - Phone:785-582-4247
Mailing Address - Fax:785-582-4247
Practice Address - Street 1:2121 SW FAIRLAWN RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-1501
Practice Address - Country:US
Practice Address - Phone:785-581-7013
Practice Address - Fax:785-581-7014
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS45371363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200278130AMedicaid
KSQ28455Medicare UPIN
KS161380Medicare ID - Type Unspecified