Provider Demographics
NPI:1124847900
Name:MANUEL, JACKLYNE (FNP)
Entity type:Individual
Prefix:
First Name:JACKLYNE
Middle Name:
Last Name:MANUEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JACKLYNE
Other - Middle Name:
Other - Last Name:DIRKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7012 HADLEY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1236
Mailing Address - Country:US
Mailing Address - Phone:785-223-1591
Mailing Address - Fax:
Practice Address - Street 1:7501 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2927
Practice Address - Country:US
Practice Address - Phone:888-993-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS83460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily