Healthcare Provider Details

I. General information

NPI: 1558218933
Provider Name (Legal Business Name): JESSICA NICHOLE ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 CHARLOTTE ST
KANSAS CITY MO
64108-2718
US

IV. Provider business mailing address

3306 VENICE DR
COLUMBIA MO
65202-4294
US

V. Phone/Fax

Practice location:
  • Phone: 417-988-1248
  • Fax:
Mailing address:
  • Phone: 417-988-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: