Provider Demographics
NPI:1679507180
Name:DONNELL-HIGGINS, JENIFER (MD)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:DONNELL-HIGGINS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:DONNELL KOWALIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:629 S PLUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-1928
Mailing Address - Country:US
Mailing Address - Phone:620-431-4000
Mailing Address - Fax:
Practice Address - Street 1:629 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1928
Practice Address - Country:US
Practice Address - Phone:620-430-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5514207Q00000X, 207V00000X, 207VX0000X
KS04-50769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00132901OtherRAILROAD MEDICARE ID
TX742965671OtherTAX ID
KS04-50769OtherSTATE LICENSE
TX092534901Medicaid
TXK5514OtherSTATE LICENSE
TXK5514OtherSTATE LICENSE