Individual
JACLYN M VATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
106 N MAIN ST, CIMARRON, KS 67835-8880
(620) 855-4456
(620) 855-4459
Mailing address
106 N MAIN ST, CIMARRON, KS 67835
(620) 855-4456
(620) 855-4459
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
75788
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004327880002
—
KS
Enumeration date
10/24/2012
Last updated
03/03/2023
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