Provider Demographics
NPI:1588243034
Name:SPEECE, JESSICA (RNFA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SPEECE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CRESCENT WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3073
Mailing Address - Country:US
Mailing Address - Phone:636-328-9130
Mailing Address - Fax:
Practice Address - Street 1:405 SAVANNAH RIDGE DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2918
Practice Address - Country:US
Practice Address - Phone:636-244-0704
Practice Address - Fax:636-244-0704
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018004937163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant