Provider Demographics
NPI:1851893341
Name:BRITT, JESSICA RAE (FNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RAE
Last Name:BRITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-286-2080
Mailing Address - Fax:314-286-2085
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DIV IM GERIATRIC MED, STE 330
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-286-2080
Practice Address - Fax:314-286-2085
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017027828363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420056728Medicaid