MEDICARE: CRISTA L JAMOUS FNP

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	209019796	IL

General Provider Information

NPI Number	:	1710535794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTA L JAMOUS FNP

Provider Business Mailing Address
First Line	:	PO BOX 790126
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63179-0126
Country	:	US
Telephone Number	:	314-961-3038
Fax Number	:	314-961-6731

Provider Business Practice Location Address
First Line	:	7491 BIG BEND BLVD
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2101
Country	:	US
Telephone Number	:	314-961-3038
Fax Number	:	314-961-6731

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

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	09/26/2025

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