Healthcare Provider Details

I. General information

NPI: 1720498413
Provider Name (Legal Business Name): JENNIFER FITZGERALD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 METCALF AVE
OVERLAND PARK KS
66213-1324
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-0340
  • Fax: 816-932-3148
Mailing address:
  • Phone: 816-932-5678
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number05-39929
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2019033212
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: