Healthcare Provider Details

I. General information

NPI: 1306377577
Provider Name (Legal Business Name): JENNIFER MARIE RYAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COLLEGE HL
LIBERTY MO
64068-1896
US

IV. Provider business mailing address

1532 NE DEER CT
LEES SUMMIT MO
64086-5966
US

V. Phone/Fax

Practice location:
  • Phone: 816-415-5020
  • Fax:
Mailing address:
  • Phone: 913-207-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017008075
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: