Provider Demographics
NPI:1568476984
Name:RAVENSCROFT, JENNIFER E (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:RAVENSCROFT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:VOLLWEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:12208 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2812
Practice Address - Country:US
Practice Address - Phone:913-438-0868
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00906363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P70567Medicare UPIN