Individual
BRENDA LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
757 W EISENHOWER RD, LANSING, KS 66043-2215
(913) 787-3063
Mailing address
7318 BEVERLY ST, OVERLAND PARK, KS 66204-2138
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2015000862
MO
363L00000X
Nurse Practitioner
Primary
76655
KS
Other
Enumeration date
01/13/2015
Last updated
01/13/2015
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