Healthcare Provider Details

I. General information

NPI: 1922736487
Provider Name (Legal Business Name): JESSICA HOMMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S MAIN ST
SMITH CENTER KS
66967-2605
US

IV. Provider business mailing address

704 E 4TH ST
SMITH CENTER KS
66967-1802
US

V. Phone/Fax

Practice location:
  • Phone: 785-282-4973
  • Fax:
Mailing address:
  • Phone: 785-260-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: