Provider Demographics
NPI:1790495075
Name:JEMERSON, CHRISTINA LEE (AGNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LEE
Last Name:JEMERSON
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2102
Mailing Address - Country:US
Mailing Address - Phone:314-534-8600
Mailing Address - Fax:314-652-8138
Practice Address - Street 1:114 N TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2102
Practice Address - Country:US
Practice Address - Phone:314-534-8600
Practice Address - Fax:314-652-8138
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022045963363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner