Individual
MR. JEFFERY THOMAS JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5500 W KELLOGG DR, WICHITA, KS 67209-2345
(316) 685-2221
(316) 681-5599
Mailing address
5500 W KELLOGG DR, WICHITA, KS 67209-2345
(316) 685-2221
(316) 681-5599
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
13-74692-081
KS
163WP2201X
Ambulatory Care Registered Nurse
13-74692-081
KS
Other
Enumeration date
08/22/2024
Last updated
08/22/2024
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