Provider Demographics
NPI:1396943288
Name:NIPPER, JAMIE ROSANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ROSANNE
Last Name:NIPPER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ROSANNE
Other - Last Name:PFEFFERKORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1237 SADDLEBROOKE RIDGE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755
Mailing Address - Country:US
Mailing Address - Phone:573-579-9771
Mailing Address - Fax:
Practice Address - Street 1:224 WHETSTONE WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3053
Practice Address - Country:US
Practice Address - Phone:573-579-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001002493171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475697413Medicaid