Healthcare Provider Details

I. General information

NPI: 1144640806
Provider Name (Legal Business Name): JACQUELINE HOBBS WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N EUCLID AVE STE. 324
SAINT LOUIS MO
63108-1690
US

IV. Provider business mailing address

625 N EUCLID AVE STE. 324
SAINT LOUIS MO
63108-1690
US

V. Phone/Fax

Practice location:
  • Phone: 314-719-9639
  • Fax: 314-361-2414
Mailing address:
  • Phone: 314-719-9639
  • Fax: 314-361-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: