Provider Demographics
NPI:1407011349
Name:COONS, JAN L (CRNA)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:COONS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5306
Mailing Address - Country:US
Mailing Address - Phone:913-785-2292
Mailing Address - Fax:913-782-2381
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 306
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5306
Practice Address - Country:US
Practice Address - Phone:913-785-2292
Practice Address - Fax:913-782-2381
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00624533OtherRR MEDICARE
KS200563730AMedicaid
KSP00624533OtherRR MEDICARE