Provider Demographics
NPI:1679815088
Name:TAGGART, JESSICA J (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:TAGGART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3515 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2501
Mailing Address - Country:US
Mailing Address - Phone:816-777-2789
Mailing Address - Fax:816-753-0804
Practice Address - Street 1:3900 S ZINTEL WAY
Practice Address - Street 2:KADLEC CLINIC KENNEWICK PRIMARY CARE
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337
Practice Address - Country:US
Practice Address - Phone:509-942-3125
Practice Address - Fax:509-585-8173
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016027451363L00000X
WAAP60532970363L00000X
WAN360542856363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1679815088Medicaid