Provider Demographics
NPI:1063655348
Name:MOWRY, JESSICA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:MOWRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:ORTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18320 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9157
Mailing Address - Country:US
Mailing Address - Phone:913-856-5577
Mailing Address - Fax:913-856-3907
Practice Address - Street 1:18320 S CENTER ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-9157
Practice Address - Country:US
Practice Address - Phone:913-856-5577
Practice Address - Fax:913-856-3907
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-42283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine