Provider Demographics
NPI:1689259764
Name:KUSEK, JACQUELYN (APRN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:KUSEK
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 1:12330 METCALF AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1302
Mailing Address - Country:US
Mailing Address - Phone:913-317-7840
Mailing Address - Fax:
Practice Address - Street 1:12330 METCALF AVE STE 260
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1302
Practice Address - Country:US
Practice Address - Phone:913-317-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily