Individual
JACOB DANIEL CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10500 QUIVIRA RD, OVERLAND PARK, KS 66215-2373
(913) 541-5000
(913) 428-2951
Mailing address
8717 W 110TH ST STE 600, OVERLAND PARK, KS 66210-2126
(913) 428-2900
(913) 428-2951
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R046087
SD
367500000X
Certified Registered Nurse Anesthetist
2020014043
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
43-557795-102
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174504732
AAKC NPI GROUP NUMBER
—
Enumeration date
05/14/2020
Last updated
04/08/2026
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