Basic Information
| Provider Information | |||||||||
| NPI: | 1316508419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMS | ||||||||
| FirstName: | JOLEEN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BACON | ||||||||
| OtherFirstName: | JOLEEN | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1500 SW 10TH AVE | ||||||||
| Address2: | MEDICAL STAFF SERVICES | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546241 | ||||||||
| FaxNumber: | 7852704343 | ||||||||
| Practice Location | |||||||||
| Address1: | 2909 SE WALNUT DR | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666052189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852670744 | ||||||||
| FaxNumber: | 7852663490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2019 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 78843 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.