Individual
JENNIFER STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
12700 SOUTHFORK RD STE 153, SAINT LOUIS, MO 63128-3201
(314) 543-5283
Mailing address
1450 E 10TH ST, ROLLA, MO 65401-3648
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
2012021855
MO
363LF0000X
Family Nurse Practitioner
Primary
2025023492
MO
Other
Enumeration date
02/10/2014
Last updated
06/22/2025
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