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General NPI Number Information
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NPI Number | 1215337548
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Entity Type | Individual
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Provider Name | JENNIFER ANN CANFIELD APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 112 ROSS BLVD. SUITE B.
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City | DODGE CITY
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State | KS
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Zip | 67801
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Country | US
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Telephone | 620-371-6900
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Fax | 620-371-6364
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Provider Business Mailing Address
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Address Line | 3515 BROADWAY AVE.
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City | GREAT BEND
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State | KS
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Zip | 67530
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Country | US
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Telephone | 620-786-6139
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Fax | 620-786-6298
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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 | 5376495
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License Number State | KS
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