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General NPI Number Information
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NPI Number | 1245283951
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Entity Type | Individual
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Provider Name | JENNIFER DAWN EBERSOLE ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 305 W 15TH ST STE 103
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City | LIBERAL
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State | KS
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Zip | 67901-2455
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Country | US
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Telephone | 620-236-3125
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Fax |
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Provider Business Mailing Address
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Address Line | 202 W LA MESA DR
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City | DODGE CITY
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State | KS
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Zip | 67801-2838
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Country | US
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Telephone | 620-225-6821
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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 | 53-45719-111
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License Number State | KS
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