Provider Demographics
NPI:1427322015
Name:JANTZ, JESSICA M (RD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:JANTZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 NW 112TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-3686
Mailing Address - Country:US
Mailing Address - Phone:816-226-6605
Mailing Address - Fax:
Practice Address - Street 1:800 E 101ST TER
Practice Address - Street 2:STE 350
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-5310
Practice Address - Country:US
Practice Address - Phone:816-226-6605
Practice Address - Fax:816-877-9137
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA998352133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered