Provider Demographics
NPI:1336140490
Name:SVETLECIC, JENNIFER A (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:SVETLECIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MS 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:
Practice Address - Street 1:5844 NW BARRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1465
Practice Address - Country:US
Practice Address - Phone:816-880-2762
Practice Address - Fax:816-880-2770
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000170265207RP1001X
KS0430397207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
34064032OtherBCBS
MO34064022OtherBCBS KC
KS200317170AMedicaid
MO207320409Medicaid
10001796700OtherCOMMUNITY HEALTH PLAN
P00246341OtherRAILROAD MEDICARE
P00246397OtherRAILROAD MEDICARE
I29581Medicare UPIN
MO021D845Medicare ID - Type Unspecified
MO34064022OtherBCBS KC
MOX88000010Medicare PIN