Provider Demographics
NPI:1538254198
Name:FREEMAN, JOHNNA L (ARNP)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:L
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19600 E 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2301
Mailing Address - Country:US
Mailing Address - Phone:816-698-8153
Mailing Address - Fax:816-698-8165
Practice Address - Street 1:19600 E 39TH ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2301
Practice Address - Country:US
Practice Address - Phone:816-698-8153
Practice Address - Fax:816-698-8165
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9781363L00000X
KS45376363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095801Medicaid
KS460580OtherFIRSTGUARD
KS161237OtherBCBS OF KANSAS
KS200252060AMedicaid