Individual
MRS. AMANDA KATHLEEN JETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6071 TELEGRAPH RD, SAINT LOUIS, MO 63129-4758
(314) 687-2712
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2016039167
MO
363LF0000X
Family Nurse Practitioner
2016039167
MO
Other
Enumeration date
01/17/2017
Last updated
10/22/2020
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