Healthcare Provider Details

I. General information

NPI: 1841124831
Provider Name (Legal Business Name): JENNIFER M KINGDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 W 115TH ST
OVERLAND PARK KS
66211-2400
US

IV. Provider business mailing address

6860 W 115TH ST
OVERLAND PARK KS
66211-2400
US

V. Phone/Fax

Practice location:
  • Phone: 800-356-3477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13884
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: