Healthcare Provider Details

I. General information

NPI: 1437896867
Provider Name (Legal Business Name): JASON LON MEANS ATC/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 SW EAGLES PKWY
GRAIN VALLEY MO
64029-8506
US

IV. Provider business mailing address

2905 N OSAGE ST
INDEPENDENCE MO
64050-1244
US

V. Phone/Fax

Practice location:
  • Phone: 816-847-5000
  • Fax: 816-847-5002
Mailing address:
  • Phone: 913-461-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000169048
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: