Provider Demographics
NPI:1831763622
Name:BLAUFUSS, JORDAN LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LYNN
Last Name:BLAUFUSS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5367
Mailing Address - Country:US
Mailing Address - Phone:620-342-4864
Mailing Address - Fax:620-343-3545
Practice Address - Street 1:420 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5367
Practice Address - Country:US
Practice Address - Phone:203-424-8646
Practice Address - Fax:620-343-3545
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80200-072207Q00000X
KS80200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201334100AMedicaid