Healthcare Provider Details

I. General information

NPI: 1477104453
Provider Name (Legal Business Name): MADISON KATHLEEN JENSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2019
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 SHAWNEE MISSION PKWY SUITE 2203
FAIRWAY KS
66205
US

IV. Provider business mailing address

4350 SHAWNEE MISSION PKWY SUITE 2203
FAIRWAY KS
66205
US

V. Phone/Fax

Practice location:
  • Phone: 913-945-7641
  • Fax: 913-945-7604
Mailing address:
  • Phone: 913-945-7641
  • Fax: 913-945-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021040574
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78924-021
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: