Provider Demographics
NPI:1477807733
Name:WALKINSHAW, JENNIFER (RDH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WALKINSHAW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:4301 DONIPHAN DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-9120
Mailing Address - Country:US
Mailing Address - Phone:417-451-9450
Mailing Address - Fax:
Practice Address - Street 1:530 S MAIDEN LN
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3084
Practice Address - Country:US
Practice Address - Phone:417-782-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008022154124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist