MEDICARE: MS. JENNIFER MICHELLE MCELFRESH ANP

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	363L00000X	Nurse Practitioner	2005023515	MO

General Provider Information

NPI Number	:	1689804833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER MICHELLE MCELFRESH ANP

Provider Business Mailing Address
First Line	:	510 COUNTRY CHASE DR
Second Line	:	C B 8219
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-5848
Country	:	US
Telephone Number	:	314-922-6121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4533 CLAYTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1501
Country	:	US
Telephone Number	:	314-747-6417
Fax Number	:	314-747-6710

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

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	01/19/2017

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