Basic Information
| Provider Information | |||||||||
| NPI: | 1891259875 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEDDER | ||||||||
| FirstName: | JAYNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | DNP, AGPCNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9100 PARK ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662153353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772795960 | ||||||||
| FaxNumber: | 8773843106 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 PARK ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662153353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772795960 | ||||||||
| FaxNumber: | 8773843106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 53-80127-071 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LP2300X | 2021011085 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 163W00000X | 2013019630 | MO | N | Nursing Service Providers | Registered Nurse | 163W00000X | 14124413071 | KS | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 2021011085 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 53-80127-071 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.