Basic Information
| Provider Information | |||||||||
| NPI: | 1598971699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKOUSE-VOLL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SKOUSE | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | DALE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 19600 E 39TH ST S | ||||||||
| Address2: | EMERGENCY ROOM | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166987170 | ||||||||
| FaxNumber: | 8166987194 | ||||||||
| Practice Location | |||||||||
| Address1: | 19600 E 39TH ST S | ||||||||
| Address2: | EMERGENCY ROOM | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640572301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166987170 | ||||||||
| FaxNumber: | 8166987194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 03/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1500867 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.