Healthcare Provider Details

I. General information

NPI: 1194645242
Provider Name (Legal Business Name): JENNA PANEITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA CLASPELL

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 N KINGSHIGHWAY BLVD UNIT 209-210
SAINT LOUIS MO
63115-1736
US

IV. Provider business mailing address

1354 PEGASUS TRL
SAINT PETERS MO
63376-5237
US

V. Phone/Fax

Practice location:
  • Phone: 314-261-5250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2026032452
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: