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NPI Code Detail

MEDICARE: JESSICA JARVIS

MEDICARE: JESSICA JARVIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician9408091KS

General Provider Information

NPI Number : 1518303999
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA JARVIS
Provider Business Mailing Address
First Line : 300 UTAH ST
Second Line :
City : HIAWATHA
State : KS
Zip : 66434-2326
Country : US
Telephone Number : 785-742-2131
Fax Number : 785-742-6588
Provider Business Practice Location Address
First Line : 300 UTAH ST
Second Line :
City : HIAWATHA
State : KS
Zip : 66434-2326
Country : US
Telephone Number : 785-742-2131
Fax Number : 785-742-6588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2013
Last Update Date : 05/24/2023

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