Healthcare Provider Details

I. General information

NPI: 1841254596
Provider Name (Legal Business Name): JENNY A ZIPPRICH RN MSN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/11/2025
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 VISTA 1034 S BRENTWOOD
ST LOUIS MO
63117
US

IV. Provider business mailing address

3691 RUTGER AVE PROVIDER ENROLLMENT
ST LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-726-1612
  • Fax:
Mailing address:
  • Phone: 314-977-6828
  • Fax: 314-977-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number108018
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number108018
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: