Provider Demographics
NPI:1841070661
Name:GUNTER, GEORGIA JANEEN BELLE
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:JANEEN BELLE
Last Name:GUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8908 W 102ND ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4233
Mailing Address - Country:US
Mailing Address - Phone:816-341-0156
Mailing Address - Fax:
Practice Address - Street 1:21120 W 152ND ST STE 201
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5307
Practice Address - Country:US
Practice Address - Phone:913-491-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP-162013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner