Healthcare Provider Details

I. General information

NPI: 1134062086
Provider Name (Legal Business Name): JENNIFER IRENE WOOLERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SW MILMAR AVE
LEES SUMMIT MO
64081-2481
US

IV. Provider business mailing address

302 SW MILMAR AVE
LEES SUMMIT MO
64081-2481
US

V. Phone/Fax

Practice location:
  • Phone: 660-221-8416
  • Fax:
Mailing address:
  • Phone: 660-221-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025050402
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: