MEDICARE: CARE BEYOND THE BOULEVARD

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	207Q00000X	Family Medicine Physician
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1568040566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE BEYOND THE BOULEVARD

Provider Business Mailing Address
First Line	:	3150 FIBERGLASS RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66115
Country	:	US
Telephone Number	:	913-291-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 FIBERGLASS RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66115
Country	:	US
Telephone Number	:	913-291-2273
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	JAYNELL ASSMAN
Credential	:	NP
Telephone Number	:	913-291-2273

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	11/01/2023

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Directions to “CARE BEYOND THE BOULEVARD ” Practice Location

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