Healthcare Provider Details

I. General information

NPI: 1558361840
Provider Name (Legal Business Name): JESSICA W. LEA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 LAMAR AVE SUITE 230
OVERLAND PARK KS
66202-4287
US

IV. Provider business mailing address

6310 LAMAR AVE SUITE 230
OVERLAND PARK KS
66202-4287
US

V. Phone/Fax

Practice location:
  • Phone: 913-262-6851
  • Fax: 913-262-8939
Mailing address:
  • Phone: 913-262-6851
  • Fax: 913-262-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number2000172889
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number1-12942
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: