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General NPI Number Information
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NPI Number | 1114024668
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Entity Type | Individual
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Provider Name | JENNIFER H DAVISSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 1010 CARONDELET DRIVE SUITE 125
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City | KANSAS CITY
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State | MO
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Zip | 64114-2846
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Country | US
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Telephone | 816-942-1150
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Fax | 816-942-0322
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Provider Business Mailing Address
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Address Line | 4601 W 109TH ST SUITE 116
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City | OVERLAND PARK
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State | KS
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Zip | 66211-1313
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Country | US
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Telephone | 913-469-1115
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Fax | 913-469-9446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1500993
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License Number State | KS
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