Healthcare Provider Details

I. General information

NPI: 1467947317
Provider Name (Legal Business Name): JESSICA LEIGH FEGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2018
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

'PO BOX 959354 ST LOUIS MO 63195'
SAINT LOUIS MO
63195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5772
  • Fax: 314-996-7691
Mailing address:
  • Phone: 314-996-5772
  • Fax: 314-996-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018030057
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2012016897
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: