Provider Demographics
NPI:1669525721
Name:KISSINGER, JANAY (ANP)
Entity type:Individual
Prefix:
First Name:JANAY
Middle Name:
Last Name:KISSINGER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 HOLMES RD STE 430
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1167
Mailing Address - Country:US
Mailing Address - Phone:816-361-5525
Mailing Address - Fax:816-361-5775
Practice Address - Street 1:6675 HOLMES RD STE 430
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1167
Practice Address - Country:US
Practice Address - Phone:816-361-5525
Practice Address - Fax:816-361-5775
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105860363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425945607Medicaid
MOL148662Medicare ID - Type Unspecified
S67952Medicare UPIN
KSL149242AMedicare PIN
MO500029586Medicare PIN