Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 44567 | KS |
NPI | 1033113576 |
---|---|
Provider Name | Jenny S Ecord |
First Address | Kansas City, MO 64108-4619 |
Second Address | Wichita, KS 67208-3052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 04/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200104550B | (05) | OK |
200421040B | (05) | KS |
Q76259 | (02) | KS |