Provider Demographics
NPI:1932622859
Name:BRISTOW, JANTSEN ALLISON (PA-C)
Entity type:Individual
Prefix:
First Name:JANTSEN
Middle Name:ALLISON
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871353
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-1353
Mailing Address - Country:US
Mailing Address - Phone:816-584-8100
Mailing Address - Fax:
Practice Address - Street 1:5810 NW BARRY RD STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1400
Practice Address - Country:US
Practice Address - Phone:816-584-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017024878363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant