Healthcare Provider Details

I. General information

NPI: 1457597924
Provider Name (Legal Business Name): NATALIE MARTHA JEFFERY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 W 19TH STREET
FORT LEONARD WOOD MO
65473
US

IV. Provider business mailing address

262 W 19TH STREET
FORT LEONARD WOOD MO
65473
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-7736
  • Fax:
Mailing address:
  • Phone: 573-596-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018036801
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000145480
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: