Healthcare Provider Details

I. General information

NPI: 1285016295
Provider Name (Legal Business Name): JODIE CARPENTER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 S. MCCLEARY RD
EXCELSIOR SPRINGS MO
64024
US

IV. Provider business mailing address

PO BOX 219672
KANSAS CITY MO
64121-9672
US

V. Phone/Fax

Practice location:
  • Phone: 816-630-6071
  • Fax: 816-630-4465
Mailing address:
  • Phone: 816-360-6071
  • Fax: 816-630-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015018032
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: