Provider Demographics
NPI:1154066264
Name:FOOTE, JESSICA LEE (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:FOOTE
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1237
Mailing Address - Country:US
Mailing Address - Phone:314-251-6382
Mailing Address - Fax:
Practice Address - Street 1:2223 TECHNOLOGY DR STE 40
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7272
Practice Address - Country:US
Practice Address - Phone:636-755-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023019709363LP2300X
MO2020015824163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse