Healthcare Provider Details

I. General information

NPI: 1952838542
Provider Name (Legal Business Name): JASMINE AFIYA EBOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 SHAWNEE MISSION PKWY
WESTWOOD KS
66205-2003
US

IV. Provider business mailing address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 401-274-1122
  • Fax: 401-459-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number04-53841
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: