Individual
JACQUELINE R PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
800 RAVENHILL DR STE 100&107, ATCHISON, KS 66002-9204
(913) 367-7300
(913) 674-2030
Mailing address
800 RAVENHILL DR, ATCHISON, KS 66002-9204
(913) 367-2131
(913) 674-2023
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-80318
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016289096
PTAN
KS
05
—
30004760070001
—
KS
05
—
420100370
—
MO
Enumeration date
07/11/2021
Last updated
03/17/2026
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