Provider Demographics
NPI:1790495075
Name:JEMERSON, CHRISTINA LEE (AGNP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LEE
Last Name:JEMERSON
Suffix:
Gender:F
Credentials:AGNP
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Mailing Address - Street 1:PO BOX 7412037
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2037
Mailing Address - Country:US
Mailing Address - Phone:314-333-4100
Mailing Address - Fax:314-333-4115
Practice Address - Street 1:4320 FOREST PARK AVE
Practice Address - Street 2:STE 1100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2979
Practice Address - Country:US
Practice Address - Phone:314-333-4100
Practice Address - Fax:314-333-4115
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022045963363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420117852Medicaid