Healthcare Provider Details

I. General information

NPI: 1427532100
Provider Name (Legal Business Name): JESSICA A REUSS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FRANK SCOTT PKWY W STE 908
BELLEVILLE IL
62223-5000
US

IV. Provider business mailing address

2900 FRANK SCOTT PKWY W STE 908
BELLEVILLE IL
62223-5000
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-9200
  • Fax: 618-234-3940
Mailing address:
  • Phone: 618-234-9200
  • Fax: 618-234-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030447
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number2018004949
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: