Provider Demographics
NPI:1689893448
Name:MCKENNEY, JENNIFER BACANI (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BACANI
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 MADISON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-1704
Mailing Address - Country:US
Mailing Address - Phone:620-378-3700
Mailing Address - Fax:
Practice Address - Street 1:1525 MADISON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1751
Practice Address - Country:US
Practice Address - Phone:630-378-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1689893448OtherBCBS OF KANSAS
KSKA1524OtherMEDICARE PTAN
KS200531470BMedicaid
KS014075001Medicare PIN