Provider Demographics
NPI:1316821382
Name:JESSICA LAVERONI, JESSICA LAVERONI RAYE
Entity type:Individual
Prefix:
First Name:JESSICA LAVERONI
Middle Name:RAYE
Last Name:JESSICA LAVERONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-2038
Mailing Address - Country:US
Mailing Address - Phone:417-621-1451
Mailing Address - Fax:
Practice Address - Street 1:1208 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-2038
Practice Address - Country:US
Practice Address - Phone:417-621-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015045031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse