Provider Demographics
NPI:1528409992
Name:RHOADS, JENNIFER D (WHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:RHOADS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1873
Mailing Address - Country:US
Mailing Address - Phone:417-256-1838
Mailing Address - Fax:417-256-5822
Practice Address - Street 1:1627 GIBSON ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1873
Practice Address - Country:US
Practice Address - Phone:417-256-1838
Practice Address - Fax:417-256-5822
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024824363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1528409992Medicaid