Provider Demographics
NPI:1891259875
Name:TEDDER, JAYNE (DNP, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:TEDDER
Suffix:
Gender:F
Credentials:DNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 PARK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3353
Mailing Address - Country:US
Mailing Address - Phone:877-279-5960
Mailing Address - Fax:877-384-3106
Practice Address - Street 1:9100 PARK ST STE 100
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3353
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:877-384-3106
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-80127-071363LP2300X, 363LA2200X
MO2021011085363LP2300X, 363LA2200X
MO2013019630163W00000X
KS14124413071163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health