1497944797 NPI number — JENNIFER DAWN ANDERSON ARNP

Table of content: JENNIFER DAWN ANDERSON ARNP (NPI 1497944797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497944797 NPI number — JENNIFER DAWN ANDERSON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
JENNIFER
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497944797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 NW 62ND TER
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64151-2408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-584-8884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 RAINBOW BLVD
Provider Second Line Business Practice Location Address:
STE G600
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66160-8500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-588-9600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  46080 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200587770A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1497944797 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".