Provider Demographics
NPI:1285016295
Name:CARPENTER, JODIE (NP-C)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-360-6071
Mailing Address - Fax:816-630-4465
Practice Address - Street 1:199 S. MCCLEARY RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024
Practice Address - Country:US
Practice Address - Phone:816-630-6071
Practice Address - Fax:816-630-4465
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015018032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily