Healthcare Provider Details

I. General information

NPI: 1467395368
Provider Name (Legal Business Name): MARISSA JACOBSON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7200
  • Fax: 816-404-7062
Mailing address:
  • Phone: 816-404-7200
  • Fax: 816-404-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01714
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2024002457
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: