Provider Demographics
NPI:1578501383
Name:WEBB, JENIFER C (NP)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:C
Last Name:WEBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3035
Mailing Address - Country:US
Mailing Address - Phone:417-621-6600
Mailing Address - Fax:417-621-6613
Practice Address - Street 1:3015 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3035
Practice Address - Country:US
Practice Address - Phone:417-621-6600
Practice Address - Fax:417-621-6613
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143435363L00000X
KS76333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6030000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MO603D782Medicare ID - Type Unspecified
MOQ59168Medicare UPIN