Provider Demographics
NPI:1649238585
Name:ETHERTON-STILL, JANA J (RN,MSN,CPNP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:J
Last Name:ETHERTON-STILL
Suffix:
Gender:F
Credentials:RN,MSN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-7411
Mailing Address - Country:US
Mailing Address - Phone:816-792-3923
Mailing Address - Fax:
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3424
Practice Address - Fax:816-855-1948
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133430363LP0200X
KS45517363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425872603Medicaid
KS100423310AMedicaid