Healthcare Provider Details

I. General information

NPI: 1639127947
Provider Name (Legal Business Name): JENNIFER L KINNEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD
KANSAS CITY MO
64111
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400S
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-3679
  • Fax: 816-932-9089
Mailing address:
  • Phone: 816-502-8756
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100889
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2010035298
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: