Healthcare Provider Details

I. General information

NPI: 1063064152
Provider Name (Legal Business Name): JESSICA MICHELLE CROFT MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15928 W 84TH TER
LENEXA KS
66219-2039
US

IV. Provider business mailing address

345 N RIVERVIEW ST STE 412
WICHITA KS
67203-4202
US

V. Phone/Fax

Practice location:
  • Phone: 913-653-3356
  • Fax:
Mailing address:
  • Phone: 551-295-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78855-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: