Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2009035999 | MO |
NPI | 1013248004 |
---|---|
Provider Name | Mrs. Lisa Ann Jennings |
First Address | Kansas City, MO 64131 |
Second Address | Kansas City, MO 64111-5939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 17/03/2018 |