Individual
MRS. JENNIFER S PROCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3901 RAINBOW BLVD MSC 3010, KANSAS CITY, KS 66160-0001
(913) 588-6719
(913) 588-4676
Mailing address
PO BOX 411851, KANSAS CITY, MO 64141-1851
(913) 588-6701
(913) 588-6677
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
15-00984
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200266580A
—
KS
Enumeration date
12/19/2006
Last updated
10/22/2015
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