Provider Demographics
NPI:1598971699
Name:SKOUSE-VOLL, JENNIFER D (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:SKOUSE-VOLL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DALE
Other - Last Name:SKOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19600 E 39TH ST S
Mailing Address - Street 2:EMERGENCY ROOM
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2301
Mailing Address - Country:US
Mailing Address - Phone:816-698-7170
Mailing Address - Fax:816-698-7194
Practice Address - Street 1:19600 E 39TH ST S
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2301
Practice Address - Country:US
Practice Address - Phone:816-698-7170
Practice Address - Fax:816-698-7194
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P67875Medicare UPIN