1477104453 NPI number — MRS. MADISON KATHLEEN JENSEN NP

Table of content: MRS. MADISON KATHLEEN JENSEN NP (NPI 1477104453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477104453 NPI number — MRS. MADISON KATHLEEN JENSEN NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENSEN
Provider First Name:
MADISON
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477104453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4350 SHAWNEE MISSION PKWY SUITE 2203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRWAY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-945-7641
Provider Business Mailing Address Fax Number:
913-945-7604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4350 SHAWNEE MISSION PKWY
Provider Second Line Business Practice Location Address:
SUITE 2203
Provider Business Practice Location Address City Name:
FAIRWAY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-945-7641
Provider Business Practice Location Address Fax Number:
913-945-7604
Provider Enumeration Date:
09/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  53-78924-021 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 2021040574 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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