Healthcare Provider Details

I. General information

NPI: 1629409362
Provider Name (Legal Business Name): NATASCHA R JEFFRIES FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASCHA R RICE

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 8TH ST STE 120
EAST SAINT LOUIS IL
62201-2989
US

IV. Provider business mailing address

100 N 8TH ST STE 120
EAST SAINT LOUIS IL
62201-2989
US

V. Phone/Fax

Practice location:
  • Phone: 618-274-9105
  • Fax: 618-274-9101
Mailing address:
  • Phone: 618-274-9105
  • Fax: 618-274-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.000650
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277000650
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: