Basic Information
| Provider Information | |||||||||
| NPI: | 1023758372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JARRETT | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1832 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667621832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202405668 | ||||||||
| FaxNumber: | 6202402353 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 W SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667251276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204292101 | ||||||||
| FaxNumber: | 6204292106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2022 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2017043009 | KS | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 81291 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.