Healthcare Provider Details

I. General information

NPI: 1760028567
Provider Name (Legal Business Name): JENNIFER HOLMES REGISTERED BEHAVIOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MOORE

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 COLLEGE BLVD
LEAWOOD KS
66211-1936
US

IV. Provider business mailing address

5350 COLLEGE BLVD
LEAWOOD KS
66211-1936
US

V. Phone/Fax

Practice location:
  • Phone: 816-994-5681
  • Fax:
Mailing address:
  • Phone: 816-501-5138
  • Fax: 816-777-0626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: