Provider Demographics
NPI:1467490870
Name:NIEHOFF, JESSICA ELIZABETH (RN, ANP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:NIEHOFF
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:ELIZABETH
Other - Last Name:WORTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3585 N MOORE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-4415
Mailing Address - Country:US
Mailing Address - Phone:636-528-5281
Mailing Address - Fax:636-528-8471
Practice Address - Street 1:104 SARAH ANN BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-2038
Practice Address - Country:US
Practice Address - Phone:636-528-5281
Practice Address - Fax:636-528-8471
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO151590363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO817492419Medicare ID - Type Unspecified