Healthcare Provider Details

I. General information

NPI: 1548659675
Provider Name (Legal Business Name): JENNIFER ANN BROWN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 10/01/2022
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 NE LAKEWOOD WAY STE 130
LEES SUMMIT MO
64064-1995
US

IV. Provider business mailing address

4045 NE LAKEWOOD WAY STE 130
LEES SUMMIT MO
64064-1995
US

V. Phone/Fax

Practice location:
  • Phone: 816-886-2184
  • Fax: 816-886-2397
Mailing address:
  • Phone: 816-886-2184
  • Fax: 816-886-2397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-76654-011
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2015002657
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: