Provider Demographics
NPI:1659336774
Name:AUSTIN, JENNIE M (MD)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:M
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:M
Other - Last Name:COE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:CHILDREN'E MERCY
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3000
Mailing Address - Fax:816-234-3000
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:CHILDREN'S MERCY
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3000
Practice Address - Fax:816-234-3000
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
440546366OtherUNITED HEALTHCARE
MO507515500OtherMEDICAID
200974OtherBLUE CROSS BLUE SHIELD
MO204990105Medicaid
721499OtherHEALTHLINK
H63439OtherMERCY
MO204990105OtherMEDICAID
MO204990105Medicaid