Provider Demographics
NPI:1639700560
Name:STRUCKHOFF, JESSICA JANE (AGPNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:STRUCKHOFF
Suffix:
Gender:F
Credentials:AGPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 SAINT STEPHEN LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1454
Mailing Address - Country:US
Mailing Address - Phone:573-424-8387
Mailing Address - Fax:
Practice Address - Street 1:408 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2799
Practice Address - Country:US
Practice Address - Phone:636-449-5757
Practice Address - Fax:636-449-5750
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013003356363LP2300X
IL209.020381041.465207363LP2300X
MO2019041583363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care