Provider Demographics
NPI:1427261247
Name:NICHOLS, JESSICA (ARNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11030 OAKMONT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1120
Mailing Address - Country:US
Mailing Address - Phone:913-608-9450
Mailing Address - Fax:913-222-1944
Practice Address - Street 1:11030 OAKMONT ST STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1120
Practice Address - Country:US
Practice Address - Phone:913-608-9450
Practice Address - Fax:913-222-1944
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO154657363LF0000X
KS46022363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily