Provider Demographics
NPI:1972554376
Name:STONE, JENIFER L (ARNP)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:L
Last Name:STONE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 N WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2729
Mailing Address - Country:US
Mailing Address - Phone:316-858-2610
Mailing Address - Fax:316-858-2793
Practice Address - Street 1:2610 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2729
Practice Address - Country:US
Practice Address - Phone:316-858-2610
Practice Address - Fax:316-858-2793
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45620363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200310040FMedicaid
KS200310040DMedicaid
KS200310040EMedicaid
KSP00747801Medicare PIN
KS200310040FMedicaid
KS200310040EMedicaid
KS200310040DMedicaid
KSKA1872008Medicare PIN