Healthcare Provider Details

I. General information

NPI: 1942071576
Provider Name (Legal Business Name): JACLYN DAVIN SCHNEIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 05/30/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD
CHESTERFIELD MO
63017-3513
US

IV. Provider business mailing address

224 S WOODS MILL RD
CHESTERFIELD MO
63017-3513
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-2394
  • Fax:
Mailing address:
  • Phone: 314-576-2394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023037600
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: