| Renitra Jackson, FNP | |
|
637 Dunn Rd Ste 102a, Hazelwood, MO 63042-1755 | |
| (314) 831-8600 | |
| (314) 839-5596 |
| Full Name | Renitra Jackson |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 637 Dunn Rd Ste 102a, Hazelwood, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144399270 | NPI | - | NPPES |
| 2000164715 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 2000164715 (Missouri) | Primary |
| Entity Name | American Multispecialty Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1972559532 PECOS PAC ID: 1658365572 Enrollment ID: O20040413001412 |
| Entity Name | Oak Street Health Physicians Group Of Missouri Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669041760 PECOS PAC ID: 7315340213 Enrollment ID: O20210729003441 |
| Mailing Address | Practice Location Address |
|---|---|
| Renitra Jackson, FNP Po Box 776084, Chicago, IL 60677-0019 Ph: (314) 831-8600 | Renitra Jackson, FNP 637 Dunn Rd Ste 102a, Hazelwood, MO 63042-1755 Ph: (314) 831-8600 |
Mrs. Beth Anne Basler, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 5690 Campus Pkwy, Hazelwood, MO 63042 Phone: 314-731-8888 Fax: 314-731-8888 | |
Wilson Gachugu Ndungu, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4 Hazelwood Ln, Hazelwood, MO 63042 Phone: 314-425-9453 | |
Julie Ann Shelton, NP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 5690 Campus Pkwy, Hazelwood, MO 63042 Phone: 314-731-8888 | |
Tomma Chevon Stowers, AGNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 100 Village Sq, Hazelwood, MO 63042 Phone: 314-355-4010 Fax: 314-355-9484 | |
Chantel Yvette Dancy, MSN, APRN, FNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 415 Chez Paree Dr, Hazelwood, MO 63042 Phone: 314-465-8222 | |
Mary K Jackson, NURSE PRACTITIONER Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 7927 N Lindbergh Blvd, Hazelwood, MO 63042 Phone: 615-778-4066 |