Provider Demographics
NPI:1407125370
Name:SUHRE, JESSICA SARAH (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:SARAH
Last Name:SUHRE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-8633
Mailing Address - Country:US
Mailing Address - Phone:573-243-6227
Mailing Address - Fax:
Practice Address - Street 1:1701 LACEY STREET
Practice Address - Street 2:HOSPITALIST DEPT
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-331-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011039396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily