=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083397202
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEWEL RADFORD RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2023
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 JAMES R THOMPSON BLVD STE 2015
-----------------------------------------------------
City | EAST SAINT LOUIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62201-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-482-6959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 JAMES R THOMPSON BLVD BLDG D
-----------------------------------------------------
City | EAST SAINT LOUIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62201-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-482-6959
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 209.031195
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209.031195
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------