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General NPI Number Information
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NPI Number | 1417371576
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Entity Type | Individual
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Provider Name | JENNIFER STARK FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 06/22/2025
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Provider Practice Location Address
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Address Line | 12700 SOUTHFORK RD STE 153
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3201
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Country | US
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Telephone | 314-543-5283
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 E 10TH ST
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City | ROLLA
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State | MO
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Zip | 65401-3648
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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 | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 2012021855
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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 | 2025023492
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License Number State | MO
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