Healthcare Provider Details

I. General information

NPI: 1548604549
Provider Name (Legal Business Name): JESSICA MCCANN L.R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2013
Last Update Date: 04/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

IV. Provider business mailing address

315 W MISSION ST
SAINT MARYS KS
66536-1533
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number22-04316
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: