Healthcare Provider Details

I. General information

NPI: 1063808145
Provider Name (Legal Business Name): JENNIE MABREY HEARING SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 W 95TH ST
LENEXA KS
66215-3806
US

IV. Provider business mailing address

12519 W 97TH TERRACE APT 201
LENEXA KS
66215
US

V. Phone/Fax

Practice location:
  • Phone: 913-541-1429
  • Fax:
Mailing address:
  • Phone: 913-541-1429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2050
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: