Provider Demographics
NPI:1790256121
Name:MACMAHON, JESSICA RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:MACMAHON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:MACMAHON-GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:KS
Mailing Address - Zip Code:67455-0406
Mailing Address - Country:US
Mailing Address - Phone:785-524-4403
Mailing Address - Fax:
Practice Address - Street 1:624 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:KS
Practice Address - Zip Code:67455-1738
Practice Address - Country:US
Practice Address - Phone:785-524-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78452-022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily