Provider Demographics
NPI:1275892291
Name:DIVINEY, JESSICA
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:DIVINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BEDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24527 119TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-6803
Mailing Address - Country:US
Mailing Address - Phone:913-683-2404
Mailing Address - Fax:
Practice Address - Street 1:24527 119TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-6803
Practice Address - Country:US
Practice Address - Phone:913-683-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant