Individual
JESSE R CHISUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSN,RN
Contact information
Practice address
4974 MANCHESTER AVE, SAINT LOUIS, MO 63110-2010
(314) 652-4100
Mailing address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
2010029883
MO
Other
Enumeration date
04/13/2026
Last updated
04/13/2026
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