Provider Demographics
NPI:1285619767
Name:ROWLETT, JAN C (RN ARNP CRNA)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:C
Last Name:ROWLETT
Suffix:
Gender:F
Credentials:RN ARNP CRNA
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:C
Other - Last Name:ROUSSEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN ARNP CRNA
Mailing Address - Street 1:PO BOX 25097
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-5097
Mailing Address - Country:US
Mailing Address - Phone:913-268-4133
Mailing Address - Fax:913-268-4138
Practice Address - Street 1:916 HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8885
Practice Address - Country:US
Practice Address - Phone:620-223-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1454603052163W00000X
KS54279363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
10001519005OtherCOMMUNITY HEALTH PLAN
MO66048A008OtherTRICARE WPS
R76304OtherPREFERRED HEALTH SYSTEMS
22140086OtherBLUE CROSS BLUE SHIELD KC
KS100247920GMedicaid
MO914807532Medicaid
KSP00407087OtherRAILROAD MEDICARE
144901OtherBLUE CROSS BLUE SHIELD KS
145351OtherBLUE CROSS BLUE SHIELD KS
KS100247920JMedicaid
22140116OtherBLUE CROSS BLUE SHIELD KC
KSP00042563OtherRAILROAD MEDICARE
MOP00042565OtherRAILROAD MEDICARE
KSW497730BMedicare PIN
22140086OtherBLUE CROSS BLUE SHIELD KC
MOW497730AMedicare PIN
144901OtherBLUE CROSS BLUE SHIELD KS
R76304Medicare UPIN
KS100247920JMedicaid
KS144901Medicare PIN