Provider Demographics
NPI:1659816189
Name:MCGEE, JENNIFER RAYE (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RAYE
Last Name:MCGEE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3023 N BALLAS RD STE 150D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2319
Mailing Address - Country:US
Mailing Address - Phone:314-996-5287
Mailing Address - Fax:314-432-6068
Practice Address - Street 1:3023 N BALLAS RD STE 150D
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2319
Practice Address - Country:US
Practice Address - Phone:314-996-5287
Practice Address - Fax:314-432-6068
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017001661363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420047214Medicaid