Healthcare Provider Details

I. General information

NPI: 1033118120
Provider Name (Legal Business Name): JENNIFER S BEQUETTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER S BIX MD

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 INDIAN CREEK PKWY
OVERLAND PARK KS
66207-4030
US

IV. Provider business mailing address

4061 INDIAN CREEK PKWY
OVERLAND PARK KS
66207-4030
US

V. Phone/Fax

Practice location:
  • Phone: 913-323-4600
  • Fax: 913-323-4748
Mailing address:
  • Phone: 913-323-4600
  • Fax: 913-323-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2002007085
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: