Jackson, Tracey L

Jackson, Tracey L is an individual health care provider with primary practice located at 615 S New Ballas Rd Sjmmc Dept Of Anes, Saint Louis MO 63141-8221. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Jackson, Tracey L can be contacted via phone (636) 386-9224.

Contact Information

Primary practice address
615 S New Ballas Rd Sjmmc Dept Of Anes Saint Louis MO 63141-8221
Phone: (636) 386-9224
Fax: (636) 386-7679
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 104201 Missouri

Profile Details

NPI number 1902808868
LBN Legal business name Jackson, Tracey L
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2005
Last updated Jul 1st, 2026 - about 3 months 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 1902808868 NPPES
Missouri MEDICAID 915005615

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