Provider Demographics
NPI:1306005624
Name:GLEN, JENNIFER L (DNP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:GLEN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:MICHALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2265 S. NINTH ST
Mailing Address - Street 2:DBA SALINA REGIONAL URGENT CARE
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-452-6000
Mailing Address - Fax:785-452-6591
Practice Address - Street 1:2265 S. NINTH ST
Practice Address - Street 2:DBA SALINA REGIONAL URGENT CARE
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-452-6000
Practice Address - Fax:785-452-6591
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005033658163W00000X, 363LF0000X
KS5375694363L00000X
KS1499928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002336OtherMEDICARE PTAN
KS201119710AMedicaid