Healthcare Provider Details

I. General information

NPI: 1447562798
Provider Name (Legal Business Name): JENNIFER LEE WOODWARD MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MS 4010
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

PO BOX 411851
KANSAS CITY MO
64141-1851
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1908
  • Fax: 913-588-8387
Mailing address:
  • Phone: 913-588-1944
  • Fax: 913-588-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-36739
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: