Provider Demographics
NPI:1194959510
Name:KUMM, JACKIE D (FNP)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:D
Last Name:KUMM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:D
Other - Last Name:SCHLAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2820 E ROCK HAVEN ROAD STE 210
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701
Mailing Address - Country:US
Mailing Address - Phone:816-380-7470
Mailing Address - Fax:816-380-3291
Practice Address - Street 1:2820 E ROCK HAVEN RD STE 210
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-4414
Practice Address - Country:US
Practice Address - Phone:816-380-7470
Practice Address - Fax:816-380-3291
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO132116OtherLICENSE NUMBER