MEDICARE: MRS. JESSICA ERIN GASSMAN FNP-C

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	363LF0000X	Family Nurse Practitioner	5375778062	KS

General Provider Information

NPI Number	:	1942544895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA ERIN GASSMAN FNP-C

Provider Business Mailing Address
First Line	:	6400 SPRINT PKWY
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66251-6107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 SPRINT PKWY
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66251-6107
Country	:	US
Telephone Number	:	913-315-6432
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/16/2012

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