MEDICARE: JAINA VALLARTA RN, MSN, APRN-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	2024025455	MO
2	363L00000X	Nurse Practitioner	2024025455	MO
3	363LA2100X	Acute Care Nurse Practitioner	26NJ00044400	NJ

General Provider Information

NPI Number	:	1497851448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAINA VALLARTA RN, MSN, APRN-BC

Provider Business Mailing Address
First Line	:	PO BOX 955534
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-5534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12266 DE PAUL DR STE 205
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2514
Country	:	US
Telephone Number	:	314-218-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	02/10/2026

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