Healthcare Provider Details

I. General information

NPI: 1144874769
Provider Name (Legal Business Name): JENNIFER ANNE KUSH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W KANSAS ST
LIBERTY MO
64068-2060
US

IV. Provider business mailing address

1901 W KANSAS ST
LIBERTY MO
64068-2060
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-0035
  • Fax:
Mailing address:
  • Phone: 816-394-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019038966
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2002018650
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: