Individual
JENNIFER BACANI MCKENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1525 MADISON ST, SUITE 3, FREDONIA, KS 66736-1751
(630) 378-3700
Mailing address
1525 MADISON ST STE 3, FREDONIA, KS 66736-1704
(620) 378-3700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6572
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689893448
BCBS OF KANSAS
KS
05
—
200531470B
—
KS
01
—
KA1524
MEDICARE PTAN
KS
Enumeration date
04/24/2007
Last updated
11/01/2015
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