Basic Information
| Provider Information | |||||||||
| NPI: | 1881239895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEHNER | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 708 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640349100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162047371 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1318 KANSAS DR | ||||||||
| Address2: | |||||||||
| City: | PAOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660712107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135575678 | ||||||||
| FaxNumber: | 9135575681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2019 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 53-79337 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 016897056 | 01 | KS | WPS | OTHER |