Healthcare Provider Details

I. General information

NPI: 1295006096
Provider Name (Legal Business Name): JESSICA LOVE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6725 SW 29TH ST
TOPEKA KS
66614-5625
US

IV. Provider business mailing address

6725 SW 29TH ST
TOPEKA KS
66614-5625
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-0517
  • Fax: 785-478-1508
Mailing address:
  • Phone: 785-354-0517
  • Fax: 785-478-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75581
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75581-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: