Provider Demographics
NPI:1952898348
Name:LEVIN, JESSICA M (NP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:LEVIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:70 JUNGERMANN CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1619
Mailing Address - Country:US
Mailing Address - Phone:636-916-9615
Mailing Address - Fax:314-653-4149
Practice Address - Street 1:70 JUNGERMANN CIR STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1619
Practice Address - Country:US
Practice Address - Phone:636-916-9615
Practice Address - Fax:314-653-4149
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017037840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1164534210Medicaid