Provider Demographics
NPI:1891340584
Name:SMITH, JESSICA L (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N. 4TH ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-1646
Mailing Address - Country:US
Mailing Address - Phone:816-230-8777
Mailing Address - Fax:816-230-8855
Practice Address - Street 1:3009 SW MOORE ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3309
Practice Address - Country:US
Practice Address - Phone:816-260-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78693-091363L00000X
MO20190105340363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner