Provider Demographics
NPI:1255569166
Name:DEXTER, MARY JANE (FNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:DEXTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:GIONTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2640
Mailing Address - Country:US
Mailing Address - Phone:816-404-0858
Mailing Address - Fax:816-404-4377
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-0858
Practice Address - Fax:816-404-4377
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-46329-022363LF0000X
MO140619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily