Provider Demographics
NPI:1649323270
Name:ST.LOUIS, JESSICA MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:ST.LOUIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 JAMES CASEY ST
Mailing Address - Street 2:STE 3A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1120
Mailing Address - Country:US
Mailing Address - Phone:614-678-0541
Mailing Address - Fax:
Practice Address - Street 1:5200 DAVIS LN STE B120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4068
Practice Address - Country:US
Practice Address - Phone:844-475-8289
Practice Address - Fax:512-450-0086
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1871213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2727599Medicaid
OHST4204043Medicare PIN
OH9257044Medicare PIN