Provider Demographics
NPI:1780078162
Name:REINAGEL, JACLYN (NP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:REINAGEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:WELKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-880-6676
Mailing Address - Fax:314-842-4372
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 403
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-880-6676
Practice Address - Fax:314-842-4372
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015008640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily