Healthcare Provider Details

I. General information

NPI: 1992467625
Provider Name (Legal Business Name): JAIME RENEE HAMILTON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 04/02/2022
Certification Date: 04/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LYNCH ST
SAINT LOUIS MO
63118-1818
US

IV. Provider business mailing address

1001 LYNCH ST
SAINT LOUIS MO
63118-1818
US

V. Phone/Fax

Practice location:
  • Phone: 636-535-5600
  • Fax: 314-615-2141
Mailing address:
  • Phone: 314-535-5600
  • Fax: 314-615-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021105703
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021042604
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: