1700480076 NPI number — MS. JESSICA JUSTINE COWAN WHNP

Table of content: MS. JESSICA JUSTINE COWAN WHNP (NPI 1700480076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700480076 NPI number — MS. JESSICA JUSTINE COWAN WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COWAN
Provider First Name:
JESSICA
Provider Middle Name:
JUSTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700480076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7412011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-454-8181
Provider Business Mailing Address Fax Number:
314-747-1429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3009 N BALLAS RD
Provider Second Line Business Practice Location Address:
DEPT OBGYN, MFM, STE 258C
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-454-8181
Provider Business Practice Location Address Fax Number:
314-747-1429
Provider Enumeration Date:
11/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  2020035539 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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