Provider Demographics
NPI:1457671604
Name:HENMAN, JESSICA (CNM, CPM, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:HENMAN
Suffix:
Gender:F
Credentials:CNM, CPM, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 CROSSWINDS CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4836
Mailing Address - Country:US
Mailing Address - Phone:314-944-3646
Mailing Address - Fax:314-405-9464
Practice Address - Street 1:1082 CROSSWINDS CT
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4836
Practice Address - Country:US
Practice Address - Phone:314-944-3646
Practice Address - Fax:314-405-9464
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
MO2010015977367A00000X
MO2024033707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife