Healthcare Provider Details

I. General information

NPI: 1427925635
Provider Name (Legal Business Name): JANE OWUSU-AGYEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 LEHNE CT
FLORISSANT MO
63031-8547
US

IV. Provider business mailing address

2222 LEHNE CT
FLORISSANT MO
63031-8547
US

V. Phone/Fax

Practice location:
  • Phone: 314-600-5808
  • Fax:
Mailing address:
  • Phone: 314-600-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2017006613
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: