Provider Demographics
NPI:1881136794
Name:JOUBERT-ROCKETT, NICHOLA ELENA (APRN)
Entity type:Individual
Prefix:
First Name:NICHOLA
Middle Name:ELENA
Last Name:JOUBERT-ROCKETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICHOLA
Other - Middle Name:ELENA
Other - Last Name:JOUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11300 CORPORATE AVE
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1374
Mailing Address - Country:US
Mailing Address - Phone:913-574-2800
Mailing Address - Fax:913-574-2336
Practice Address - Street 1:12200 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4045
Practice Address - Country:US
Practice Address - Phone:913-574-2650
Practice Address - Fax:913-574-2769
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS113352163W00000X
MO2009017318163W00000X
KS77441363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1881136794Medicaid
KS201145700AMedicaid
KS201145700AMedicaid