Healthcare Provider Details

I. General information

NPI: 1619292877
Provider Name (Legal Business Name): JONATHAN J PICARELLA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

1836 LACKLAND HILL PKWY
SAINT LOUIS MO
63146-3572
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5330
  • Fax: 314-997-0384
Mailing address:
  • Phone: 314-989-0300
  • Fax: 314-569-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2010012147
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: