Healthcare Provider Details

I. General information

NPI: 1730582313
Provider Name (Legal Business Name): JESSICA MARIE GALLAGHER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR STE 280
SAINT LOUIS MO
63141-8657
US

IV. Provider business mailing address

12855 N 40 DR STE 280
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-4415
  • Fax:
Mailing address:
  • Phone: 314-432-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014034213
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: