Provider Demographics
NPI:1851090526
Name:HAASE, JESSICA L (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:HAASE
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:COLLYER
Mailing Address - State:KS
Mailing Address - Zip Code:67631-0205
Mailing Address - Country:US
Mailing Address - Phone:913-742-3796
Mailing Address - Fax:
Practice Address - Street 1:317 AINSLIE AVE
Practice Address - Street 2:
Practice Address - City:COLLYER
Practice Address - State:KS
Practice Address - Zip Code:67631-9701
Practice Address - Country:US
Practice Address - Phone:785-657-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5381985082363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health