Healthcare Provider Details

I. General information

NPI: 1346116241
Provider Name (Legal Business Name): VIRGINIA COGDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA GRIMM

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 CHRISTY DR STE 210
JEFFERSON CITY MO
65101-5195
US

IV. Provider business mailing address

1705 CHRISTY DR STE 210
JEFFERSON CITY MO
65101-5195
US

V. Phone/Fax

Practice location:
  • Phone: 573-606-7667
  • Fax:
Mailing address:
  • Phone: 573-606-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2025045774
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: