Provider Demographics
NPI:1831636877
Name:IKNER, NORDIA DESRINE GRAHAM (NP)
Entity type:Individual
Prefix:MRS
First Name:NORDIA
Middle Name:DESRINE GRAHAM
Last Name:IKNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:NORDIA
Other - Middle Name:DESRINE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:913-789-2000
Mailing Address - Fax:
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-789-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS154169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily