Provider Demographics
NPI:1295241578
Name:JIWANI, FARAHNAZ ALI (NP-C)
Entity type:Individual
Prefix:MRS
First Name:FARAHNAZ
Middle Name:ALI
Last Name:JIWANI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:FARAHNAZ
Other - Middle Name:SHAUKAT
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:11610 W 158TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-7110
Mailing Address - Country:US
Mailing Address - Phone:913-314-2053
Mailing Address - Fax:
Practice Address - Street 1:11610 W 158TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-7110
Practice Address - Country:US
Practice Address - Phone:913-314-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019011554363LA2100X, 363LP2300X, 363LA2200X
KS53-77983-071363L00000X, 363LA2100X, 363LA2200X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS81-4072521OtherMEDICARE
MO81-4072521Medicaid