Provider Demographics
NPI:1760282131
Name:CAROLLO, JENNIFER LEAH (WHNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEAH
Last Name:CAROLLO
Suffix:
Gender:
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19550 E 39TH ST S STE 300
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2306
Mailing Address - Country:US
Mailing Address - Phone:816-478-0220
Mailing Address - Fax:816-795-3483
Practice Address - Street 1:19550 E 39TH ST S STE 300
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2306
Practice Address - Country:US
Practice Address - Phone:816-478-0220
Practice Address - Fax:816-794-3483
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017003020163W00000X
MO2025008123363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse