Healthcare Provider Details

I. General information

NPI: 1912393810
Provider Name (Legal Business Name): JOCELYN OU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDREN'S PL. CB 8116
ST. LOUIS MO
63110-6311
US

IV. Provider business mailing address

1 CHILDRENS PL CB8116
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6148
  • Fax: 314-454-4633
Mailing address:
  • Phone: 314-454-6148
  • Fax: 314-454-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number88536
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2018008659
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: