MEDICARE: JENNIFER DAWN EBERSOLE ARNP

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	363LF0000X	Family Nurse Practitioner	53-45719-111	KS

General Provider Information

NPI Number	:	1245283951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DAWN EBERSOLE ARNP

Provider Business Mailing Address
First Line	:	202 W LA MESA DR
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2838
Country	:	US
Telephone Number	:	620-225-6821
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W 15TH ST STE 103
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-2455
Country	:	US
Telephone Number	:	620-236-3125
Fax Number	:

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/19/2025

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