Healthcare Provider Details

I. General information

NPI: 1366648453
Provider Name (Legal Business Name): ROBIN DECOURSEY JENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBIN LAUREL DECOURSEY M.D.

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 11/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

8717 W 110TH ST SUITE 600
OVERLAND PARK KS
66210-2144
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3000
  • Fax:
Mailing address:
  • Phone: 913-428-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number2012018300
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: