Provider Demographics
NPI:1265400980
Name:ELLIOTT, JENNIFER A (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:ELLIOTT
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 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-9712
Mailing Address - Country:US
Mailing Address - Phone:816-502-8756
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4321 WASHINGTON ST STE 1200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5905
Practice Address - Country:US
Practice Address - Phone:816-932-2932
Practice Address - Fax:816-932-5491
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110737207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOW19B535Medicare PIN
MOF06B535DMedicare ID - Type Unspecified
H54746Medicare UPIN
MOJ24000003Medicare PIN
H54746Medicare UPIN
KS100415130CMedicaid
MOJ24000003Medicare PIN