Healthcare Provider Details

I. General information

NPI: 1619574936
Provider Name (Legal Business Name): JESSICA MARIE BOOKER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61
FESTUS MO
63028-4100
US

IV. Provider business mailing address

1400 US HIGHWAY 61 STE H1521
FESTUS MO
63028-4100
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6663
  • Fax:
Mailing address:
  • Phone: 314-251-6663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2008018755
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021002799
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: