Provider Demographics
NPI:1083873558
Name:PATTERSON, JENNIFER J (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:MARCELLUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4721 S CLIFF AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7016
Mailing Address - Country:US
Mailing Address - Phone:816-503-3700
Mailing Address - Fax:816-503-3704
Practice Address - Street 1:4721 S CLIFF AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7016
Practice Address - Country:US
Practice Address - Phone:816-503-3700
Practice Address - Fax:816-503-3704
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008008631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1083873558Medicaid
KS200574010AMedicaid
MOP00649479Medicare PIN
MOP09000001Medicare PIN