Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2012003666 | MO |
Y | 213ES0000X | Sports Medicine | 2012003666 | MO |
NPI | 1184258188 |
---|---|
Provider Name | Mrs. Jessica Nicole Bledsoe |
First Address | Kansas City, MO 64116-2160 |
Second Address | Saint Joseph, MO 64505-9323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2020 |
Last Update Date | 27/02/2020 |