Healthcare Provider Details

I. General information

NPI: 1033113576
Provider Name (Legal Business Name): JENNY S ECORD A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3243 E MURDOCK ST
WICHITA KS
67208-3052
US

IV. Provider business mailing address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 316-500-8900
  • Fax:
Mailing address:
  • Phone: 816-234-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number44567
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: