Provider Demographics
NPI:1639696743
Name:FAIRCHILDS, JESSICA COLLINS (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:COLLINS
Last Name:FAIRCHILDS
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:AARON
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, PMHNP
Mailing Address - Street 1:4300 BRENNER DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104-1163
Mailing Address - Country:US
Mailing Address - Phone:913-334-0294
Mailing Address - Fax:913-334-0284
Practice Address - Street 1:21350 W 153RD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5413
Practice Address - Country:US
Practice Address - Phone:913-216-4396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79148-102363LP0808X
MO2020009152363LP0808X
MS901911363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care