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General NPI Number Information
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NPI Number | 1356073712
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Entity Type | Individual
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Provider Name | JAIME RENEE RENFRO FNP
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Gender | Female
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Dates
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Enumeration Date | 06/25/2022
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 3527 W TRUMAN BLVD
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-5901
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Country | US
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Telephone | 573-893-7848
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Fax | 573-893-1984
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Provider Business Mailing Address
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Address Line | PO BOX 505673
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City | SAINT LOUIS
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State | MO
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Zip | 63150-5673
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2022024062
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2022024062
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2022024062
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License Number State | MO
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