Provider Demographics
NPI:1861258766
Name:THIBAULT, JENNIFER (DNP, MBA, RN,DIPACLM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:THIBAULT
Suffix:
Gender:F
Credentials:DNP, MBA, RN,DIPACLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11626 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-8784
Mailing Address - Country:US
Mailing Address - Phone:785-341-5984
Mailing Address - Fax:
Practice Address - Street 1:11626 S WATER ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8784
Practice Address - Country:US
Practice Address - Phone:785-341-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1386721081163W00000X
261QF0400X
KS5383530081363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty