Provider Demographics
NPI:1588963144
Name:IRWIN, JENNY R (FNP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:IRWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 LEES SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64139-1236
Mailing Address - Country:US
Mailing Address - Phone:816-404-7000
Mailing Address - Fax:816-404-7110
Practice Address - Street 1:7900 LEES SUMMIT RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64139-1236
Practice Address - Country:US
Practice Address - Phone:816-404-7000
Practice Address - Fax:816-404-7110
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011007619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428822803Medicaid
MO599225901Medicaid
MO1588963144Medicaid
MO595956202Medicaid
MO540568508Medicaid
MO595985805Medicaid
MO595956103Medicaid
MO599225901Medicaid
MO595956202Medicaid
268551Medicare Oscar/Certification
261320Medicare Oscar/Certification
P270000Medicare PIN
268549Medicare Oscar/Certification
P27000028Medicare PIN
268550Medicare Oscar/Certification