Provider Demographics
NPI:1689441669
Name:KERSHNER, JENNIFER RENE'
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENE'
Last Name:KERSHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W 110TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1215
Mailing Address - Country:US
Mailing Address - Phone:913-234-7600
Mailing Address - Fax:
Practice Address - Street 1:5100 W 110TH ST STE 120
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1215
Practice Address - Country:US
Practice Address - Phone:913-234-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024000041363L00000X
KS53-82777-031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner