Healthcare Provider Details

I. General information

NPI: 1700214608
Provider Name (Legal Business Name): JACLYN C HEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN C RAPP

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 OLD BALLAS RD STE 100
SAINT LOUIS MO
63141-7068
US

IV. Provider business mailing address

711 OLD BALLAS RD STE 100
SAINT LOUIS MO
63141-7068
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-0510
  • Fax: 314-569-1085
Mailing address:
  • Phone: 314-569-0510
  • Fax: 314-569-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013038962
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: