Provider Demographics
NPI:1306952379
Name:SHOWALTER, JEANINE R (FNP-BC; AOCNP)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:R
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:FNP-BC; AOCNP
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:R
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12140 NALL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2503
Mailing Address - Country:US
Mailing Address - Phone:913-498-7409
Mailing Address - Fax:913-498-7470
Practice Address - Street 1:12140 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2503
Practice Address - Country:US
Practice Address - Phone:913-498-7409
Practice Address - Fax:913-498-7470
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-84910-102163W00000X
KS45928363LF0000X
MO2000165819163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1306952379Medicaid
KS200407400BMedicaid
Q71083Medicare UPIN
KS200407400BMedicaid
KSP00953230Medicare PIN