Healthcare Provider Details

I. General information

NPI: 1306715172
Provider Name (Legal Business Name): JOCELYN DENNAE WYMS MSN-ED, RN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 383C
SAINT LOUIS MO
63131-2324
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 314-305-1447
  • Fax: 314-996-4546
Mailing address:
  • Phone: 314-305-1447
  • Fax: 314-996-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025045768
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2025045768
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: