Basic Information
Provider Information | |||||||||
NPI: | 1295187623 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CORDELL | ||||||||
FirstName: | JUDEE | ||||||||
MiddleName: | SARA MARIE | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | AGACNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3901 RAINBOW BLVD, 4070 DELP, MS 4017 | ||||||||
Address2: | KANSAS UNIVERSITY PHYSICIANS, INC. | ||||||||
City: | KANSAS CITY | ||||||||
State: | KS | ||||||||
PostalCode: | 661600001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9135882501 | ||||||||
FaxNumber: | 9135883877 | ||||||||
Practice Location | |||||||||
Address1: | 3901 RAINBOW BLVD, 6040 DELP, MS 1020 | ||||||||
Address2: | DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY | ||||||||
City: | KANSAS CITY | ||||||||
State: | KS | ||||||||
PostalCode: | 661600001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9135886005 | ||||||||
FaxNumber: | 9135883877 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/11/2016 | ||||||||
LastUpdateDate: | 12/20/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 53-77248-102 | KS | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.