Provider Demographics
NPI:1679193908
Name:MENSE, JAMIE RENE (APRN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:RENE
Last Name:MENSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RANSOM
Mailing Address - State:KS
Mailing Address - Zip Code:67572-9525
Mailing Address - Country:US
Mailing Address - Phone:785-731-2295
Mailing Address - Fax:785-731-2882
Practice Address - Street 1:206 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:RANSOM
Practice Address - State:KS
Practice Address - Zip Code:67572-9525
Practice Address - Country:US
Practice Address - Phone:785-731-2295
Practice Address - Fax:785-731-2882
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS80567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004800370001Medicaid