Healthcare Provider Details

I. General information

NPI: 1780098475
Provider Name (Legal Business Name): JESSICA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 EAST 45TH STREET NORTH
BEL AIRE KS
67226
US

IV. Provider business mailing address

6700 EAST 45TH STREET NORTH
BEL AIRE KS
67226
US

V. Phone/Fax

Practice location:
  • Phone: 316-744-2020
  • Fax:
Mailing address:
  • Phone: 316-744-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: