Healthcare Provider Details

I. General information

NPI: 1265400980
Provider Name (Legal Business Name): JENNIFER A. ELLIOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST STE 1200
KANSAS CITY MO
64111-5905
US

IV. Provider business mailing address

901 E. 104TH ST. MAILSTOP 400N
KANSAS CITY MO
64131-9712
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2932
  • Fax: 816-932-5491
Mailing address:
  • Phone: 816-502-8756
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number110737
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: