MEDICARE: JESSICA MIES APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	53-80220-051	KS

General Provider Information

NPI Number	:	1386219921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MIES APRN

Provider Business Mailing Address
First Line	:	615 BIERMANN ST
Second Line	:
City	:	GARDEN PLAIN
State	:	KS
Zip	:	67050-5020
Country	:	US
Telephone Number	:	316-393-9579
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 BIERMANN ST
Second Line	:
City	:	GARDEN PLAIN
State	:	KS
Zip	:	67050-5020
Country	:	US
Telephone Number	:	316-393-9579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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