MEDICARE: JESSICA LYNN HALL

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
1	171000000X	Military Health Care Provider
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1558837799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN HALL

Provider Business Mailing Address
First Line	:	6301 N LUCERNE AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64151-3105
Country	:	US
Telephone Number	:	816-525-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	2861 NE INDEPENDENCE AVE
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064-2350
Country	:	US
Telephone Number	:	816-525-5840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	08/18/2025

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