Provider Demographics
NPI:1770092173
Name:GARRETT, JACINDA N (FNP)
Entity type:Individual
Prefix:
First Name:JACINDA
Middle Name:N
Last Name:GARRETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-599-9261
Mailing Address - Fax:
Practice Address - Street 1:20 NE SAINT LUKES BLVD STE 240
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6019
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-751-8635
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017037378363LF0000X, 363LF0000X
KS14-134819-022163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse