Provider Demographics
NPI:1679879571
Name:KENNEDY, JESSA (NP)
Entity type:Individual
Prefix:
First Name:JESSA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2489
Mailing Address - Country:US
Mailing Address - Phone:785-295-8000
Mailing Address - Fax:785-295-5355
Practice Address - Street 1:634 SW MULVANE ST STE 209
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1678
Practice Address - Country:US
Practice Address - Phone:785-295-5330
Practice Address - Fax:785-295-5355
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO188050163W00000X
CONP-990139363LX0001X
KS80791363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse