Healthcare Provider Details

I. General information

NPI: 1902042930
Provider Name (Legal Business Name): JESSICA ANN THOMURE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 CLAYTON RD
BALLWIN MO
63011-2713
US

IV. Provider business mailing address

14400 CLAYTON RD
BALLWIN MO
63011-2713
US

V. Phone/Fax

Practice location:
  • Phone: 636-207-1137
  • Fax: 314-748-5919
Mailing address:
  • Phone: 636-207-1137
  • Fax: 314-748-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2001016534
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: