Healthcare Provider Details

I. General information

NPI: 1649793076
Provider Name (Legal Business Name): JENIFER INSLEY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 S GREYSTONE CT
SPRINGFIELD MO
65804-6561
US

IV. Provider business mailing address

3808 S GREYSTONE CT
SPRINGFIELD MO
65804-6561
US

V. Phone/Fax

Practice location:
  • Phone: 417-889-3332
  • Fax: 417-881-1410
Mailing address:
  • Phone: 417-889-3332
  • Fax: 417-881-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2011010498
License Number StateMO

VIII. Authorized Official

Name: MICHELLE HAWKINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-889-3332