Healthcare Provider Details

I. General information

NPI: 1437402856
Provider Name (Legal Business Name): ANGELA M JONES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9904 CLAYTON RD STE 135
SAINT LOUIS MO
63124-1149
US

IV. Provider business mailing address

9904 CLAYTON RD STE 135
SAINT LOUIS MO
63124-1149
US

V. Phone/Fax

Practice location:
  • Phone: 314-397-6805
  • Fax:
Mailing address:
  • Phone: 314-397-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016023914
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022044304
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number151969
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: