Provider Demographics
NPI:1114024668
Name:DAVISSON, JENNIFER H (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:H
Last Name:DAVISSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4601 W 109TH ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1313
Mailing Address - Country:US
Mailing Address - Phone:913-469-1115
Mailing Address - Fax:913-469-9446
Practice Address - Street 1:1010 CARONDELET DRIVE
Practice Address - Street 2:SUITE 125
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2846
Practice Address - Country:US
Practice Address - Phone:816-942-1150
Practice Address - Fax:816-942-0322
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2021-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1500993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48-1209044OtherEIN
KS189D459Medicare ID - Type UnspecifiedMEDICARE NUMBER
KSQ30480Medicare UPIN