Provider Demographics
NPI:1992747844
Name:RICHARD, JILLIAN RACHELLE (APRN, FNP-C, BC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RACHELLE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:APRN, FNP-C, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 METCALF AVE
Mailing Address - Street 2:STE. 500A
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1324
Mailing Address - Country:US
Mailing Address - Phone:913-317-3170
Mailing Address - Fax:913-317-3192
Practice Address - Street 1:12330 METCALF AVE
Practice Address - Street 2:STE. 500A
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-3170
Practice Address - Fax:913-317-3192
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002026672363LF0000X
KS45793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG930000014Medicare PIN
MOH74000004Medicare PIN