MEDICARE: MRS. JEAN R MCCAMMON MSN, ANP-BC, ACNP-BC

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
1	363L00000X	Nurse Practitioner	137755	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	206587	OTHER	MO	BLUE CROSS BLUE SHIELD
2	733111	OTHER	MO	HEALTHLINK

General Provider Information

NPI Number	:	1528000700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN R MCCAMMON MSN, ANP-BC, ACNP-BC

Provider Business Mailing Address
First Line	:	12639 OLD TESSON RD
Second Line	:	SUITE 115
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2786
Country	:	US
Telephone Number	:	314-849-0311
Fax Number	:	314-849-4423

Provider Business Practice Location Address
First Line	:	13319 MANCHESTER RD
Second Line	:
City	:	DES PERES
State	:	MO
Zip	:	63131-1710
Country	:	US
Telephone Number	:	314-822-1060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	06/15/2023

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