Provider Demographics
NPI:1225562598
Name:VANCE, JAMIE LEIGH (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEIGH
Last Name:VANCE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEIGH
Other - Last Name:COPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13515 BARRETT PARKWAY DR
Mailing Address - Street 2:STE 170
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5870
Mailing Address - Country:US
Mailing Address - Phone:314-775-2811
Mailing Address - Fax:314-775-2821
Practice Address - Street 1:400 S WOODS MILL RD
Practice Address - Street 2:STE 140
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3429
Practice Address - Country:US
Practice Address - Phone:314-485-1101
Practice Address - Fax:314-485-1104
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017011124367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered