Provider Demographics
NPI:1932485794
Name:WURTH, JAMIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:WURTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:BENHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-386-7679
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:DEPT. OF ANESTHESIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-4687
Practice Address - Fax:314-251-4241
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011032982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily