| Doctor Name: | MS. JESSICA EILEEN MARTIN |
| NPI Number: | 1134467368 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, RN, FNP-BC |
| License Number: | 2004020222 |
| Business Practice Address: | 506 4th St La Grande, OR - 978501906 |
| Business Phone Number: | 5416633138 |
| Business Fax Number: | |
| Mailing Address: | 8705 Nw 82nd St Apt A, KANSAS CITY |
| State: | MO |
| Postal Code: | 641524145 |
| Phone Number: | 8165174877 |
| Fax Number: | |
| NPI Enumeration Date: | 01/23/2013 |
| NPI Last Update Date: | 08/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2004020222 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |