Provider Demographics
NPI:1619172632
Name:COLLETTE, JO ELLEN (FNP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5151 TROOST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-2543
Mailing Address - Country:US
Mailing Address - Phone:816-237-1616
Mailing Address - Fax:816-237-1655
Practice Address - Street 1:5151 TROOST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-2543
Practice Address - Country:US
Practice Address - Phone:816-237-1616
Practice Address - Fax:816-237-1655
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007014466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007014466OtherLICENSE