Provider Demographics
NPI:1730259425
Name:SATTLER, JACKIE LYNN (FNP)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:LYNN
Last Name:SATTLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:LYNN
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:420 WOLLARD BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-1974
Mailing Address - Country:US
Mailing Address - Phone:816-470-2131
Mailing Address - Fax:816-470-7171
Practice Address - Street 1:420 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1974
Practice Address - Country:US
Practice Address - Phone:816-470-2131
Practice Address - Fax:816-470-7171
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001004392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO595956202Medicaid
MO595956400Medicaid
MO540568508Medicaid
MO427515804Medicaid
MO595985805Medicaid
MO599225901Medicaid
MO010568509Medicaid
MO595956103Medicaid
MO010568509Medicaid
MO599225901Medicaid
MO595956400Medicaid
MO595956103Medicaid
MO540568508Medicaid
P27E930Medicare PIN
MO595956202Medicaid
MO595985805Medicaid
MO427515804Medicaid
268548Medicare Oscar/Certification
261320Medicare PIN
MOMA6134004Medicare PIN
Q73835Medicare UPIN