Provider Demographics
NPI:1770206765
Name:CUNNINGHAM, JORDAN ALEXANDRA (APRN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALEXANDRA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9301 W 74TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2217
Mailing Address - Country:US
Mailing Address - Phone:913-632-9100
Mailing Address - Fax:
Practice Address - Street 1:9301 W 74TH ST STE 100
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2217
Practice Address - Country:US
Practice Address - Phone:913-632-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS140383163WX0200X
KS5381597102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology