MEDICARE: JESSICA HOMMON

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	225000000X	Orthotic Fitter

General Provider Information

NPI Number	:	1922736487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HOMMON

Provider Business Mailing Address
First Line	:	704 E 4TH ST
Second Line	:
City	:	SMITH CENTER
State	:	KS
Zip	:	66967-1802
Country	:	US
Telephone Number	:	785-260-5873
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S MAIN ST
Second Line	:
City	:	SMITH CENTER
State	:	KS
Zip	:	66967-2605
Country	:	US
Telephone Number	:	785-282-4973
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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Directions to “ JESSICA HOMMON ” Practice Location

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