Healthcare Provider Details

I. General information

NPI: 1194714899
Provider Name (Legal Business Name): JENNIFER LYNN KUSSMANN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL DRIVE DC 058.00
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

ONE HOSPITAL DRIVE DC 058.00
COLUMBIA MO
65212-0001
US

V. Phone/Fax

Practice location:
  • Phone: 573-885-6735
  • Fax: 573-884-3543
Mailing address:
  • Phone: 573-885-6735
  • Fax: 573-884-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: