Healthcare Provider Details

I. General information

NPI: 1558837799
Provider Name (Legal Business Name): JESSICA LYNN HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 NE INDEPENDENCE AVE
LEES SUMMIT MO
64064-2350
US

IV. Provider business mailing address

6301 N LUCERNE AVE
KANSAS CITY MO
64151-3105
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-5840
  • Fax:
Mailing address:
  • Phone: 816-525-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: