Healthcare Provider Details

I. General information

NPI: 1871029652
Provider Name (Legal Business Name): JARED KEVERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 NW BLUE PKWY
LEES SUMMIT MO
64086-5705
US

IV. Provider business mailing address

4014 SW FLINTROCK DR
LEES SUMMIT MO
64082-4871
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-5600
  • Fax:
Mailing address:
  • Phone: 913-940-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70499-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2020025522
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: