Provider Demographics
NPI:1558837799
Name:DEERING, JESSICA LYNN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:DEERING
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 1:2900 MERGANSER WAY
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-5466
Mailing Address - Country:US
Mailing Address - Phone:313-969-4332
Mailing Address - Fax:
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 1230
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3253
Practice Address - Country:US
Practice Address - Phone:816-841-3805
Practice Address - Fax:816-214-9330
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider