Basic Information
| Provider Information | |||||||||
| NPI: | 1548864838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 MCCABE ST | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671562515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202627107 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 E 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671562407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202212300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2020 | ||||||||
| LastUpdateDate: | 11/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 53-79592-041 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.