Provider Demographics
NPI:1760298152
Name:KINGREY, JESSIE L (AUD)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:L
Last Name:KINGREY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:LYCANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9513 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2037
Mailing Address - Country:US
Mailing Address - Phone:304-654-0028
Mailing Address - Fax:
Practice Address - Street 1:458 NE 291 HWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-2501
Practice Address - Country:US
Practice Address - Phone:816-507-8885
Practice Address - Fax:816-533-4344
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2537231H00000X
KS237700000X
MO231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist