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General NPI Number Information
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NPI Number | 1174959365
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Entity Type | Individual
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Provider Name | JENNIFER UTTERBACK APRN-C
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Gender | Female
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 20 NW R.D. MIZE ROAD EMERGENCY DEPARTMENT
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-4411
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Country | US
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Telephone | 816-655-5472
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Fax |
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Provider Business Mailing Address
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Address Line | 201 NW R D MIZE RD EMERGENCY DEPARTMENT
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-2513
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Country | US
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Telephone | 816-655-5472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 65688
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 53-79796-122
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2013032468
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License Number State | MO
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