Individual
JANA J. ETHERTON-STILL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN,MSN,CPNP
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3424
(816) 855-1948
Mailing address
1008 ASPEN DR, LIBERTY, MO 64068-7411
(816) 792-3923
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
133430
MO
363LP0200X
Pediatric Nurse Practitioner
45517
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100423310A
—
KS
05
—
425872603
—
MO
Enumeration date
05/02/2006
Last updated
07/08/2007
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