Individual
JENNIFER K. THEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3401 MCINTOSH CIR STE 100, JOPLIN, MO 64804-3651
(417) 347-7200
(417) 347-7236
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 347-4662
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
142538
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091520A
—
OK
05
—
100380720A
—
KS
01
—
148311
ANTHEM
MO
05
—
425136306
—
MO
01
—
500014242
RR MEDICARE
—
Enumeration date
06/27/2006
Last updated
03/19/2024
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