Healthcare Provider Details

I. General information

NPI: 1598978710
Provider Name (Legal Business Name): JENNIFER ANN GRONER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7650
  • Fax: 816-404-7612
Mailing address:
  • Phone: 816-218-2523
  • Fax: 816-285-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2009013302
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: