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NPI Code Detail

MEDICARE: JESSE R CHISUM BSN,RN

MEDICARE: JESSE R CHISUM BSN,RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP2201XAmbulatory Care Registered Nurse2010029883MO

General Provider Information

NPI Number : 1013850072
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE R CHISUM BSN,RN
Provider Business Mailing Address
First Line : 915 N GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63106-1621
Country : US
Telephone Number : 314-652-4100
Fax Number :
Provider Business Practice Location Address
First Line : 4974 MANCHESTER AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2010
Country : US
Telephone Number : 314-652-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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Directions to “ JESSE R CHISUM BSN,RN” Practice Location

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