Provider Demographics
NPI:1851802714
Name:NATION, JACK ANDREW (LAT, ATC, ROT, OBT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:ANDREW
Last Name:NATION
Suffix:
Gender:M
Credentials:LAT, ATC, ROT, OBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 W 91ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2035
Mailing Address - Country:US
Mailing Address - Phone:913-687-8585
Mailing Address - Fax:
Practice Address - Street 1:7500 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-3502
Practice Address - Country:US
Practice Address - Phone:913-687-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170341502255A2300X
KS24-012332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer