Provider Demographics
NPI:1588985600
Name:JAKLEVIC, DEBORAH A (MSN, APRN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:JAKLEVIC
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2659
Mailing Address - Country:US
Mailing Address - Phone:816-960-3050
Mailing Address - Fax:916-960-3038
Practice Address - Street 1:3101 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2659
Practice Address - Country:US
Practice Address - Phone:816-960-3050
Practice Address - Fax:816-960-3038
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010009581363LF0000X
KS5375104012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily