Provider Demographics
NPI:1700920600
Name:SHIELDS, JENNY R
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:R
Other - Last Name:BILLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2246 ORVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-4751
Mailing Address - Country:US
Mailing Address - Phone:913-279-1643
Mailing Address - Fax:
Practice Address - Street 1:2246 ORVILLE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-4751
Practice Address - Country:US
Practice Address - Phone:913-279-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKOO600035343900000X
KSK00-60-0035343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)