Individual
JESSICA LEIGH FEGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3015 N BALLAS RD, SAINT LOUIS, MO 63131-2329
(314) 996-5772
(314) 996-7691
Mailing address
'PO BOX 959354 ST LOUIS MO 63195', SAINT LOUIS, MO 63195-0001
(314) 996-5772
(314) 996-7691
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
2012016897
MO
363L00000X
Nurse Practitioner
Primary
2018030057
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012016897
RN LICENSE
MO
Enumeration date
06/23/2018
Last updated
10/13/2025
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