Provider Demographics
NPI:1154870624
Name:DEJONG, MALIA (APRN)
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:DEJONG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MALIA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5101 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1614
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:
Practice Address - Street 1:5701 W 119TH ST STE 425
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3755
Practice Address - Country:US
Practice Address - Phone:913-721-3387
Practice Address - Fax:816-875-2598
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77376-011363LF0000X
MO2016035740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily