MEDICARE: JENNY S ECORD A.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	44567	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033113576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY S ECORD A.R.N.P.

Provider Business Mailing Address
First Line	:	2401 GILLHAM RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-4619
Country	:	US
Telephone Number	:	816-234-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3243 E MURDOCK ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67208-3052
Country	:	US
Telephone Number	:	316-500-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/04/2014

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