Provider Demographics
NPI:1356990360
Name:NIEDENS, JESSIE M (AGACNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:M
Last Name:NIEDENS
Suffix:
Gender:F
Credentials:AGACNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 HI ST
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2333
Mailing Address - Country:US
Mailing Address - Phone:719-371-2708
Mailing Address - Fax:
Practice Address - Street 1:2305 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6203
Practice Address - Country:US
Practice Address - Phone:620-801-3320
Practice Address - Fax:620-225-8687
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995013363L00000X
MDR252784363LP2300X
KS53-83034-091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care