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Individual
DR. JENNIFER L GLEN
Active
Individual
DR. JENNIFER L GLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1499928
KS
163W00000X
Registered Nurse
2005033658
MO
363L00000X
Nurse Practitioner
Primary
5375694
KS
363LF0000X
Family Nurse Practitioner
2005033658
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002336
MEDICARE PTAN
KS
05
—
201119710A
—
KS
Enumeration date
06/02/2008
Last updated
12/02/2016
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