Healthcare Provider Details

I. General information

NPI: 1497997126
Provider Name (Legal Business Name): JENNIFER SUMMERS PA-C, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD STE 58W
CHESTERFIELD MO
63017-3664
US

IV. Provider business mailing address

226 S WOODS MILL RD STE 58W
CHESTERFIELD MO
63017-3664
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-2888
  • Fax: 314-576-8187
Mailing address:
  • Phone: 314-878-2888
  • Fax: 314-576-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number011491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: