Provider Demographics
NPI:1255112645
Name:BRAIN FIRST FAMILY CENTER LLC
Entity type:Organization
Organization Name:BRAIN FIRST FAMILY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BVC
Authorized Official - Phone:913-399-1924
Mailing Address - Street 1:15621 W 87TH ST # 264
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1435
Mailing Address - Country:US
Mailing Address - Phone:913-399-1924
Mailing Address - Fax:913-940-1045
Practice Address - Street 1:8700 MONROVIA ST STE 310
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3500
Practice Address - Country:US
Practice Address - Phone:913-399-1924
Practice Address - Fax:913-940-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty