Provider Demographics
NPI:1467092783
Name:LAWSON, JESSE LEE (FNP)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LEE
Last Name:LAWSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4484 WESTMINSTER PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1813
Mailing Address - Country:US
Mailing Address - Phone:314-518-0814
Mailing Address - Fax:
Practice Address - Street 1:2015 MAPLEWOOD COMMONS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-1003
Practice Address - Country:US
Practice Address - Phone:314-293-4023
Practice Address - Fax:314-293-4285
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019039806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily