Organization
J BOATMAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY BOATMAN MSN (OWNER)
(314) 753-5184
Entity
Organization
Contact information
Practice address
11475 OLDE CABIN RD STE 120, CREVE COEUR, MO 63141-7128
(314) 647-4488
(314) 647-6305
Mailing address
5807 MANGO DR, SAINT LOUIS, MO 63129-2243
(314) 753-5184
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
11805
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
580714
ANTHEM BCBS
MO
Enumeration date
02/01/2011
Last updated
10/10/2022
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