Individual
TERRI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3015 N BALLAS RD, SAINT LOUIS, MO 63131-2329
(314) 996-5330
(314) 810-1399
Mailing address
3015 N BALLAS RD, SAINT LOUIS, MO 63131-2329
(314) 996-5330
(314) 810-1399
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
126514
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
126514
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
918437401
—
MO
01
—
P00161434
RAILROAD MEDICARE
MO
Enumeration date
02/03/2006
Last updated
08/22/2017
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