Healthcare Provider Details

I. General information

NPI: 1710431432
Provider Name (Legal Business Name): JACQUELYNN VICTORIA TITUS FNP, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYNN V. FERGUSON

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15740 S OUTER 40 RD
CHESTERFIELD MO
63017-2004
US

IV. Provider business mailing address

627 LEGENDS VIEW DR
EUREKA MO
63025-2090
US

V. Phone/Fax

Practice location:
  • Phone: 417-521-2437
  • Fax: 636-237-4015
Mailing address:
  • Phone: 636-675-9687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2020039600
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020039600
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: