Healthcare Provider Details

I. General information

NPI: 1780437178
Provider Name (Legal Business Name): JENNIFER R RUCKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SE MORELAND SCHOOL RD
BLUE SPRINGS MO
64014-5037
US

IV. Provider business mailing address

100 SE MORELAND SCHOOL RD
BLUE SPRINGS MO
64014-5037
US

V. Phone/Fax

Practice location:
  • Phone: 816-935-6072
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024009820
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: