Healthcare Provider Details

I. General information

NPI: 1194695932
Provider Name (Legal Business Name): PRECISION HEALTH AND DIAGNOSTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4818 WASHINGTON BLVD
SAINT LOUIS MO
63108-1829
US

IV. Provider business mailing address

4818 WASHINGTON BLVD STE 4013
SAINT LOUIS MO
63108-1829
US

V. Phone/Fax

Practice location:
  • Phone: 314-948-4602
  • Fax: 314-590-2757
Mailing address:
  • Phone: 314-948-4602
  • Fax: 314-590-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASSMA DAVIS
Title or Position: REGISTER NURSE/ LAB DIRECTOR
Credential: ASN
Phone: 314-948-4602