Individual
JESSICA H DIEKHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Contact information
Practice address
12855 N FORTY DR, STE 280, ST. LOUIS, MO 63141
(314) 432-4415
(314) 432-1986
Mailing address
12855 N FORTY DR, STE 280, ST. LOUIS, MO 63141
(314) 432-4415
(314) 432-1986
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
140356
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164662276
—
MO
01
—
P01134602
RAILROAD MEDICARE
MO
01
—
P22480
UPIN
—
Enumeration date
03/02/2009
Last updated
07/15/2014
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