Healthcare Provider Details

I. General information

NPI: 1831591684
Provider Name (Legal Business Name): JACQUELINE D TEBEEST FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE NELSON

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW MOCK AVE STE 200
BLUE SPRINGS MO
64014-2500
US

IV. Provider business mailing address

100 NW MOCK AVE STE 200
BLUE SPRINGS MO
64014-2500
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-1000
  • Fax: 816-463-6035
Mailing address:
  • Phone: 816-228-1000
  • Fax: 816-463-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2014032509
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014032509
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: