Healthcare Provider Details

I. General information

NPI: 1649844820
Provider Name (Legal Business Name): JESSICA N LYNCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA SHELTON PA-C

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201B ANDERSON AVE STE 2
MANHATTAN KS
66503-7601
US

IV. Provider business mailing address

2200 SW 6TH AVE STE 104
TOPEKA KS
66606-1707
US

V. Phone/Fax

Practice location:
  • Phone: 785-320-7774
  • Fax: 785-320-7758
Mailing address:
  • Phone: 785-354-8518
  • Fax: 785-354-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02917
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: