Healthcare Provider Details

I. General information

NPI: 1508509910
Provider Name (Legal Business Name): WALAA MAHMOUD MOHAMMAD AL JAWARNEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 W 127TH ST
OVERLAND PARK KS
66213-2714
US

IV. Provider business mailing address

8000 W 127TH ST
OVERLAND PARK KS
66213-2714
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6492
  • Fax: 913-588-6414
Mailing address:
  • Phone: 913-688-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number94-12118
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: