Provider Demographics
NPI:1306812730
Name:CARLSON, JANAE (ARNP)
Entity type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 PROGRESS DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-6345
Mailing Address - Country:US
Mailing Address - Phone:913-632-9940
Mailing Address - Fax:913-680-1275
Practice Address - Street 1:1004 PROGRESS DR STE 130
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6345
Practice Address - Country:US
Practice Address - Phone:913-632-9940
Practice Address - Fax:913-680-1275
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100448990AMedicaid
KSP82017Medicare UPIN
KS100448990AMedicaid
KS160938Medicare PIN
KSJ64C257Medicare PIN