Healthcare Provider Details

I. General information

NPI: 1649107814
Provider Name (Legal Business Name): JAKOB OWENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

6254 POINTVIEW LN
SAINT LOUIS MO
63123-1736
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5000
  • Fax:
Mailing address:
  • Phone: 573-620-3289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2019023058
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: