Individual
MS. JESSICA LYNN LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
1133 DUNN RD, SUITE 2335, ST LOUIS, MO 63136-6119
(314) 653-5007
(314) 653-5007
Mailing address
11133 DUNN RD, SUITE 2335, SAINT LOUIS, MO 63136-6119
(314) 653-5007
(314) 653-4149
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
060472784
IL
163WE0003X
Emergency Registered Nurse
2010040204
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
2015028258
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073980611
—
MO
Enumeration date
08/31/2015
Last updated
07/21/2022
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