Provider Demographics
NPI:1487684015
Name:FREEMAN, JENNIFER L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:FREEMAN
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:PO BOX 2150
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-2150
Mailing Address - Country:US
Mailing Address - Phone:417-348-8964
Mailing Address - Fax:417-336-0275
Practice Address - Street 1:1150 STATE HIGHWAY 248
Practice Address - Street 2:SUITE 202
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3758
Practice Address - Country:US
Practice Address - Phone:417-348-8964
Practice Address - Fax:417-336-0275
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010031549208000000X
KS27666208000000X
OK26612208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100355930AMedicaid
KS12149433OtherMULTIPLAN
KS12721OtherPHS
KS17012OtherCOVENTRY
KS057913OtherBCBS
KS109998OtherHPK
OK200212490AMedicaid
KS100355930AMedicaid
KS12721OtherPHS