Provider Demographics
NPI:1740504273
Name:WELLER, JILL KRISTINE (ANP)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:KRISTINE
Last Name:WELLER
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7450 KESSLER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2553
Mailing Address - Country:US
Mailing Address - Phone:913-632-9480
Mailing Address - Fax:913-632-9499
Practice Address - Street 1:7450 KESSLER ST STE 202
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2553
Practice Address - Country:US
Practice Address - Phone:913-632-9480
Practice Address - Fax:913-632-9499
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010009590363LA2200X
KS53-75289363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health