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NPI Code Detail

MEDICARE: JENNIFER MARIE JARVIS M.DIV., B.C.C.

MEDICARE: JENNIFER MARIE JARVIS M.DIV., B.C.C.
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
1374K00000XReligious Nonmedical Practitioner24599

General Provider Information

NPI Number : 1669170338
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARIE JARVIS M.DIV., B.C.C.
Provider Business Mailing Address
First Line : 4600 EDMUNDSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-3806
Country : US
Telephone Number : 314-733-7176
Fax Number :
Provider Business Practice Location Address
First Line : 4600 EDMUNDSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-3806
Country : US
Telephone Number : 314-733-7176
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2023
Last Update Date : 02/21/2023

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