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General NPI Number Information
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NPI Number | 1669294419
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Entity Type | Individual
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Provider Name | JESSICA KIMMEL RDH
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 123 N TYLER RD STE 100
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City | WICHITA
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State | KS
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Zip | 67212-3726
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Country | US
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Telephone | 316-648-5418
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Fax |
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Provider Business Mailing Address
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Address Line | 8240 S BUTTERFLY ST
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City | CLEARWATER
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State | KS
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Zip | 67026-8577
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Country | US
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Telephone | 316-648-5418
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 13439
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number |
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License Number State |
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