Jessica Lynn Provines, TLMLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

997 Issued in KS

Practice address

7570 W 21St St N
Wichita, KS 67205-1734

Phone

(316) 729-6555

Fax

(316) 634-4794

NPI assigned

Sep 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Prairie View, Inc.

  • Psychiatry Physician
  • Newton, KS
  • NPI 1558426486
  NPD (past)
• Prairie View, Inc.

  • Psychiatric Hospital
  • Wichita, KS
  • NPI 1902251655
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710083183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 N HOOD ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672032846",
            "telephone_number": "316-655-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7570 W 21ST ST N",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051734",
            "telephone_number": "316-729-6555",
            "fax_number": "316-634-4794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVINES",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "TLMLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Frank Provenzano, MD
• John R Provenzano, DDS
• Providence Home Health & Hospice LLC
• Providence Home Health & Hospice LLC.
• Providence Physical Therapy
• Macey Pruett, OD
• Micaela Elizabeth Pruiett, LPC
• Mary Molly Loren Pruit
• Lou Ann Prusa, LCMFT
• John C Pryor, LCPC, LPC

• Clinical Psychologist in Wichita, KS
• Providers in Wichita, KS by specialty
• Clinical Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.