Provider Demographics
NPI:1164218616
Name:EAGLE, JESSICA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:EAGLE
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11609 S GLEASON RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7786
Mailing Address - Country:US
Mailing Address - Phone:913-306-4666
Mailing Address - Fax:
Practice Address - Street 1:14425 COLLEGE BLVD STE 111
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2184
Practice Address - Country:US
Practice Address - Phone:913-353-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach