Healthcare Provider Details

I. General information

NPI: 1003268152
Provider Name (Legal Business Name): JESSICA LYN BURICH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYN THOMPSON RN, BSN

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 01/02/2025
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 MACKLIND AVE
SAINT LOUIS MO
63110-1440
US

IV. Provider business mailing address

1129 MACKLIND AVE
SAINT LOUIS MO
63110-1440
US

V. Phone/Fax

Practice location:
  • Phone: 314-534-0200
  • Fax: 314-534-7996
Mailing address:
  • Phone: 314-534-0200
  • Fax: 314-534-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022043250
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: