Provider Demographics
NPI:1760839823
Name:LUEBBERING, JESSICA CYNTHIA (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CYNTHIA
Last Name:LUEBBERING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:CYNTHIA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:551 VETERANS UNITED DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8397
Practice Address - Country:US
Practice Address - Phone:573-882-4730
Practice Address - Fax:573-884-4899
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019046354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty