Healthcare Provider Details

I. General information

NPI: 1487684015
Provider Name (Legal Business Name): JENNIFER L FREEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 STATE HIGHWAY 248 SUITE 202
BRANSON MO
65616-3758
US

IV. Provider business mailing address

PO BOX 2150
LOWELL AR
72745-2150
US

V. Phone/Fax

Practice location:
  • Phone: 417-348-8964
  • Fax: 417-336-0275
Mailing address:
  • Phone: 417-348-8964
  • Fax: 417-336-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2010031549
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number27666
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26612
License Number StateOK

VII. Legacy identifiers

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

# 1
Identifier100355930A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 2
Identifier12149433
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerMULTIPLAN
# 3
Identifier12721
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerPHS
# 4
Identifier17012
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerCOVENTRY
# 5
Identifier057913
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerBCBS
# 6
Identifier109998
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerHPK
# 7
Identifier200212490A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: