Healthcare Provider Details

I. General information

NPI: 1316458870
Provider Name (Legal Business Name): SUSAN MARY JONES AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 11/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV ORTHO SURG ADULT RECONSTRUCTIVE SURG
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8233
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2551
  • Fax: 314-747-2598
Mailing address:
  • Phone: 314-514-3500
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2017035894
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: