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NPI Code Detail

MEDICARE: JESSICA WHITLOCK

MEDICARE: JESSICA WHITLOCK
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
1363LF0000XFamily Nurse Practitioner2015039026MO
2363LF0000XFamily Nurse Practitioner2006032006MO

General Provider Information

NPI Number : 1295107506
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA WHITLOCK
Provider Business Mailing Address
First Line : PO BOX 776084
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6084
Country : US
Telephone Number : 314-821-1313
Fax Number : 314-821-5670
Provider Business Practice Location Address
First Line : 1000 DES PERES RD STE 310
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63131-2039
Country : US
Telephone Number : 314-821-1313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2015
Last Update Date : 09/20/2023

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Directions to “ JESSICA WHITLOCK ” Practice Location

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