Individual
MRS. JESSICA C. KISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA-C
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(636) 386-7222
Mailing address
PO BOX 22407, SAINT LOUIS, MO 63126-0407
(636) 386-7222
(636) 200-4036
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
2013035993
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184051625
—
MO
Enumeration date
09/30/2013
Last updated
02/10/2020
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