Provider Demographics
NPI:1922736487
Name:HOMMON, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HOMMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SMITH CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66967-1802
Mailing Address - Country:US
Mailing Address - Phone:785-260-5873
Mailing Address - Fax:
Practice Address - Street 1:121 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITH CENTER
Practice Address - State:KS
Practice Address - Zip Code:66967-2605
Practice Address - Country:US
Practice Address - Phone:785-282-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter