Healthcare Provider Details

I. General information

NPI: 1760282131
Provider Name (Legal Business Name): JENNIFER LEAH CAROLLO WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE SAINT LUKES BLVD FL 3
LEES SUMMIT MO
64086-1000
US

IV. Provider business mailing address

120 NE SAINT LUKES BLVD FL 3
LEES SUMMIT MO
64086-1000
US

V. Phone/Fax

Practice location:
  • Phone: 816-251-5780
  • Fax: 816-251-5781
Mailing address:
  • Phone: 816-251-5780
  • Fax: 816-251-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2017003020
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2025008123
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: