Healthcare Provider Details

I. General information

NPI: 1023649399
Provider Name (Legal Business Name): JESSICA HARTZLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2337
US

IV. Provider business mailing address

3521 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2337
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-8346
  • Fax: 816-554-9470
Mailing address:
  • Phone: 816-554-8346
  • Fax: 816-554-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2021036598
License Number StateMO
# 2
Primary TaxonomyN
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: