Individual
JENNA MATTHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10004 KENNERLY RD STE 374B, SAINT LOUIS, MO 63128-2178
(314) 842-9669
(314) 842-1017
Mailing address
PO BOX 802841, KANSAS CITY, MO 64180-2841
(314) 842-9669
(314) 842-1017
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2019028561
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AG06190154
AMERICAN ACADEMY OF NURSE PRACTITIONERS
—
Enumeration date
11/21/2019
Last updated
12/11/2023
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