Provider Demographics
NPI:1124918735
Name:WIERSHING, JESSICA MICHELE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELE
Last Name:WIERSHING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13107 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2933
Mailing Address - Country:US
Mailing Address - Phone:913-280-2620
Mailing Address - Fax:
Practice Address - Street 1:6528 E 128TH TER
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1923
Practice Address - Country:US
Practice Address - Phone:913-280-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant