Healthcare Provider Details

I. General information

NPI: 1659336774
Provider Name (Legal Business Name): JENNIE M AUSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIE M COE

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD CHILDREN'S MERCY
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM RD CHILDREN'E MERCY
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3000
  • Fax: 816-234-3000
Mailing address:
  • Phone: 816-234-3000
  • Fax: 816-234-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2005031069
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: