Provider Demographics
NPI:1003268152
Name:BURICH, JESSICA LYN (PMHNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYN
Last Name:BURICH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:2025 S BRENTWOOD BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1851
Mailing Address - Country:US
Mailing Address - Phone:636-949-5760
Mailing Address - Fax:866-440-9231
Practice Address - Street 1:2025 S BRENTWOOD BLVD STE 209
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1851
Practice Address - Country:US
Practice Address - Phone:636-949-5760
Practice Address - Fax:866-440-9231
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022043250363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health