Healthcare Provider Details

I. General information

NPI: 1013827807
Provider Name (Legal Business Name): JENNA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 N TULLIS DR
KANSAS CITY MO
64157-7890
US

IV. Provider business mailing address

1101 NE 66TH TER
GLADSTONE MO
64118-3568
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-9667
  • Fax:
Mailing address:
  • Phone: 816-806-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: