Provider Demographics
NPI:1346034931
Name:KIENTZY, JESSICA R (MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:KIENTZY
Suffix:
Gender:
Credentials:MSN, PMHNP
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 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:17844 E 23RD ST S
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1840
Practice Address - Country:US
Practice Address - Phone:816-254-3652
Practice Address - Fax:816-254-9243
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014024533163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse