Provider Demographics
NPI:1154300101
Name:PHILLIPS, JENNIFER G (DPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:GALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4860 COLLEGE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1681
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:816-875-2597
Practice Address - Street 1:8919 PARALLEL PKWY STE 331
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1655
Practice Address - Country:US
Practice Address - Phone:816-478-4200
Practice Address - Fax:816-875-2597
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0345213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS33395016OtherBLUE CROSS/BLUE SHIELD
KSP00425788OtherRAILROAD MEDICARE
KS33395016OtherBLUE CROSS/BLUE SHIELD
KSQ99D129Medicare PIN