Provider Demographics
NPI:1194061242
Name:KLEOPFER, JENESSA D (PA)
Entity type:Individual
Prefix:MRS
First Name:JENESSA
Middle Name:D
Last Name:KLEOPFER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1525 MADISON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-1703
Mailing Address - Country:US
Mailing Address - Phone:620-378-2068
Mailing Address - Fax:620-378-2312
Practice Address - Street 1:1525 MADISON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1703
Practice Address - Country:US
Practice Address - Phone:620-378-2068
Practice Address - Fax:620-378-2312
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KST-03507363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical