Jennifer Leann Bader, FNP
Individual provider Active NPI Family Nurse Practitioner · Kennett, MO
NPI 1114277803 · NPPES record last updated Mar 12, 2020
Key facts
- NPI
- 1114277803
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2005022001 (MO)
- Practice address
- 920 Kennett St
Kennett, MO 63857-3817 - Phone
- (573) 717-1130
- NPI assigned
- Sep 11, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- FCC Medical Clinics LLC
Practice addresses (Care Compare)
900 State Route VV
Kennett, MO 63857-3834
Phone (573) 559-2365
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121106000399 | MO | Practitioner - Nurse Practitioner | 8123279841 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005022001 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FCC Medical Clinics LLC | Current |
Accepting new patients | |
| Family Counseling Center, Inc. | Past | Accepting new patients |
Locations
900 State Route VV
Kennett, MO 63857
Phone (573) 559-2365
3001 Warrior Ln
Poplar Bluff, MO 63901
Phone (573) 785-7453
Interoperability endpoints
- https://api.platform.athenahealth.com/14764/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2005022001 | MO | Yes |
Addresses
Primary practice location
920 Kennett St
Kennett, MO 63857-3817
Mailing address
6738 State Highway 77
Benton, MO 63736-8238
Phone (573) 313-2500
Other names
- Jennifer Leann Lawrence
Other providers in Kennett, MO
- Arcadia Ego Inc
- Arcadia Ego Inc
- Virginia Suzanne Armstrong
- Hayden Austin
- Brittany Elisabeth Axelson
- Alexis Leanna Baker
- Jordan Baker
- Eddie R Ballard
- Elsie Barbosa
- Alison Taylor Barnes
All providers in Kennett, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.