Provider Demographics
NPI:1144874769
Name:KUSH, JENNIFER ANNE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:KUSH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 SE POWELL RD
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:MO
Mailing Address - Zip Code:64465-8100
Mailing Address - Country:US
Mailing Address - Phone:816-394-0144
Mailing Address - Fax:
Practice Address - Street 1:13101 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1650
Practice Address - Country:US
Practice Address - Phone:816-942-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018650163W00000X
MO2019038966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse