Healthcare Provider Details

I. General information

NPI: 1386219921
Provider Name (Legal Business Name): JESSICA MIES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 BIERMANN ST
GARDEN PLAIN KS
67050-5020
US

IV. Provider business mailing address

615 BIERMANN ST
GARDEN PLAIN KS
67050-5020
US

V. Phone/Fax

Practice location:
  • Phone: 316-393-9579
  • Fax:
Mailing address:
  • Phone: 316-393-9579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-80220-051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: