Basic Information
| Provider Information | |||||||||
| NPI: | 1750667648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AXLEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 BUSINESS PARK DR SUITE A | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633798903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365416248 | ||||||||
| FaxNumber: | 8555404722 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 BUSINESS PARK DRIVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633792828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6367289460 | ||||||||
| FaxNumber: | 6367751544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2011 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 148289 | MO | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 2011003426 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.