Healthcare Provider Details

I. General information

NPI: 1467092783
Provider Name (Legal Business Name): JESSE LEE LAWSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MAPLEWOOD COMMONS DR
SAINT LOUIS MO
63143-1003
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-293-4023
  • Fax: 314-293-4285
Mailing address:
  • Phone: 314-862-5044
  • Fax: 314-862-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2019022790
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019039806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: