Healthcare Provider Details

I. General information

NPI: 1467379560
Provider Name (Legal Business Name): JASICA VESTAL FSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22518 CONESTOGA RD APT 1
FORT RILEY KS
66442-3199
US

IV. Provider business mailing address

22518 CONESTOGA RD APT 1
FORT RILEY KS
66442-3199
US

V. Phone/Fax

Practice location:
  • Phone: 931-320-9847
  • Fax:
Mailing address:
  • Phone: 931-272-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: