Provider Demographics
NPI:1972929545
Name:MORAN, JENNIFER (FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DOCKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPAWINGO
Mailing Address - State:MO
Mailing Address - Zip Code:64015-9403
Mailing Address - Country:US
Mailing Address - Phone:913-645-7245
Mailing Address - Fax:
Practice Address - Street 1:7111 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111-2406
Practice Address - Country:US
Practice Address - Phone:913-645-7245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-84822-031163W00000X
MO2000146301163W00000X
MO2014007481363LC0200X, 363LF0000X, 363LP2300X
KS53-76854-031363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-76854-031OtherLICENSE
MO2000146301OtherLICENSE
2013025793OtherANCC