Healthcare Provider Details

I. General information

NPI: 1619821105
Provider Name (Legal Business Name): JESSICA RENE MOLINARI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 KENNERLY RD STE 400
SAINT LOUIS MO
63128-2197
US

IV. Provider business mailing address

10012 KENNERLY RD STE 400
SAINT LOUIS MO
63128-2197
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-5999
  • Fax: 314-543-5994
Mailing address:
  • Phone: 314-543-5999
  • Fax: 314-543-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026008550
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: