Provider Demographics
NPI:1508309717
Name:LUCIDO, JESSICA PEARL MEI-JAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:PEARL MEI-JAN
Last Name:LUCIDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:PEARL ME-JAN
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:625 S. NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 2015
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-1100
Mailing Address - Fax:314-251-1140
Practice Address - Street 1:625 S. NEW BALLAS ROAD
Practice Address - Street 2:SUITE 2015
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-1100
Practice Address - Fax:314-251-1140
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012020364163W00000X
MO2016012526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse