Healthcare Provider Details

I. General information

NPI: 1285133546
Provider Name (Legal Business Name): JENNIFER MICHELLE USSACK FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 S NOLAND RD
INDEPENDENCE MO
64055-3344
US

IV. Provider business mailing address

2704 NE WHEATLEY DR
BLUE SPRINGS MO
64029-7732
US

V. Phone/Fax

Practice location:
  • Phone: 816-254-6002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82977-051
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number91913
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018003290
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10067272
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: