Provider Demographics
NPI:1013499235
Name:PEARSON, JENELLE (NP)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 COLLEGE BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1606
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:913-297-1202
Practice Address - Street 1:340 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2150
Practice Address - Country:US
Practice Address - Phone:913-722-3100
Practice Address - Fax:913-722-2542
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS000000000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner