Individual
MS. JELYA INGRID FATAWU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHMP-BC
Contact information
Practice address
4 LIBERTY GROVE CT, WENTZVILLE, MO 63385-7188
(216) 246-5697
(314) 216-3851
Mailing address
4 LIBERTY GROVE CT, WENTZVILLE, MO 63385-7188
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2022035166
MO
Other
Enumeration date
11/01/2022
Last updated
04/07/2025
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