Healthcare Provider Details

I. General information

NPI: 1619367596
Provider Name (Legal Business Name): JACQUELIN HOHLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

5253 SUTHERLAND AVE APARTMENT A
SAINT LOUIS MO
63109-2338
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-9300
  • Fax:
Mailing address:
  • Phone: 314-799-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014042602
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: