Provider Demographics
NPI:1851397889
Name:PROVERBS, JANETTA C (MD)
Entity Type:Individual
Prefix:
First Name:JANETTA
Middle Name:C
Last Name:PROVERBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204
Mailing Address - Country:US
Mailing Address - Phone:913-642-7000
Mailing Address - Fax:913-642-7020
Practice Address - Street 1:505 NE 87TH AVE STE 160
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1965
Practice Address - Country:US
Practice Address - Phone:360-514-1060
Practice Address - Fax:360-514-1065
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0426209174400000X
WAMD61042142207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100193060AMedicaid
KS100193060AMedicaid
KSG26871Medicare UPIN