Provider Demographics
NPI:1457671604
Name:HENMAN, JESSICA (CPM, CNM)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:HENMAN
Suffix:
Gender:F
Credentials:CPM, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 RIVERDELL DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4777
Mailing Address - Country:US
Mailing Address - Phone:314-369-8637
Mailing Address - Fax:
Practice Address - Street 1:4035 RIVERDELL DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4777
Practice Address - Country:US
Practice Address - Phone:314-369-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
MO2010015977367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife