Individual provider Active NPI

Jessie Nichole Fazel, APRN

  • Family Nurse Practitioner
  • Overland Park, KS
National Provider Identifier
1255682076
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
75765 Issued in KS
Practice address
5808 W 110TH St
Overland Park, KS 66211-2504
Phone
(913) 696-8000
NPI assigned
Sep 20, 2012
Last updated
Mar 24, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 75765 KS Primary

Addresses

Primary practice location

5808 W 110TH St
Overland Park, KS 66211-2504

Mailing address

2401 Gillham Rd
Kansas City, MO 64108-4619
Phone (816) 701-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, MO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150122001951 KS Practitioner - Nurse Practitioner 7012231020 Reassigns benefits to 1 organization
I20210122001970 MO Practitioner - Nurse Practitioner 7012231020 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Children's Mercy Hospital CurrentSince Jan 21, 2021 Accepting new patients
The Children's Mercy Hospital CurrentSince Jan 21, 2021 Accepting new patients

Locations

5808 W 110th St
Overland Park, KS 66211
Phone (913) 696-8000

6750 W 135th St
Overland Park, KS 66223
Phone (913) 717-4700

2401 Gillham Rd
Kansas City, MO 64108
Phone (816) 234-3380

501 NW Barry Rd
Kansas City, MO 64155
Phone (816) 413-2500

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1255682076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 GILLHAM RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641084619",
            "telephone_number": "816-701-5200",
            "fax_number": "816-302-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5808 W 110TH ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662112504",
            "telephone_number": "913-696-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZEL",
        "first_name": "JESSIE",
        "middle_name": "NICHOLE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-20",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "75765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.