Healthcare Provider Details

I. General information

NPI: 1063344570
Provider Name (Legal Business Name): JESSICA MARIE KEYSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14532 S OUTER 40 RD
CHESTERFIELD MO
63017-5705
US

IV. Provider business mailing address

2113 SAINT PETERS CENTRE BLVD APT 2325
SAINT PETERS MO
63376-2629
US

V. Phone/Fax

Practice location:
  • Phone: 816-500-4421
  • Fax:
Mailing address:
  • Phone: 816-500-4421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2025035469
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: