Provider Demographics
NPI:1255075073
Name:JASPER, SARAH D (MSN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:D
Last Name:JASPER
Suffix:
Gender:F
Credentials:MSN, CPNP-PC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:D
Other - Last Name:BOLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, CPNP-PC
Mailing Address - Street 1:212 KIMBERLY CT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-5294
Mailing Address - Country:US
Mailing Address - Phone:573-259-3711
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3130
Practice Address - Country:US
Practice Address - Phone:636-390-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006023346163WM0102X
MO2022023902363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn