Individual
JENNIFER SOUTHWARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1203 SMIZER MILL RD, FENTON, MO 63026-3483
(636) 717-1350
(636) 717-1355
Mailing address
12680 OLIVE BLVD, SAINT LOUIS, MO 63141-6289
(314) 529-5660
(636) 717-1355
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2013037116
MO
Other
Enumeration date
02/24/2014
Last updated
08/05/2025
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