Healthcare Provider Details

I. General information

NPI: 1205193240
Provider Name (Legal Business Name): JENNIFER LOUISE MCKENZIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S STE 110
INDEPENDENCE MO
64057-2353
US

IV. Provider business mailing address

4125 STATE LINE RD
KANSAS CITY MO
64111-4423
US

V. Phone/Fax

Practice location:
  • Phone: 816-698-8900
  • Fax: 816-698-8905
Mailing address:
  • Phone: 816-908-9739
  • Fax: 816-908-9738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012014779
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: