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General NPI Number Information
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NPI Number | 1114745908
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Entity Type | Individual
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Provider Name | JESSICA DUTTON FNP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 4200 LITTLE BLUE PKWY STE 300
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City | INDEPENDENCE
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State | MO
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Zip | 64057-8303
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Country | US
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Telephone | 816-691-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 2125 S OUTER BELT RD
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City | OAK GROVE
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State | MO
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Zip | 64075-9600
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Country | US
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Telephone | 816-589-5346
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2024037873
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License Number State | MO
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