Jackson, Renitra

Jackson, Renitra is an individual health care provider with primary practice located at 472 N Highway 67 St , Florissant MO 63031-5102. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Jackson, Renitra can be contacted via phone (314) 343-5061.

Contact Information

Primary practice address
472 N Highway 67 St Florissant MO 63031-5102
Phone: (314) 343-5061
Fax: (314) 334-7465
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2000164715 Missouri

Profile Details

NPI number 1144399270
LBN Legal business name Jackson, Renitra
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 6th, 2006
Last updated Apr 16th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144399270 NPPES
Illinois MEDICAID 1144399270
Illinois MEDICAID 1144399270

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