Jacquelynn Danielle Baker, PA
Individual provider Active NPI Physician Assistant · Saint Louis, MO
NPI 1154445534 · NPPES record last updated Mar 14, 2025
Key facts
- NPI
- 1154445534
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 114211 (MO)
- Practice address
- 915 N Grand Blvd
Saint Louis, MO 63106-1621 - Phone
- (314) 652-4100
- Fax
- (314) 289-7058
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114211 | MO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Curators of the University of Missouri | Past | Accepting new patients | |
| Prairie Cardiovascular Consultants LTD | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 114211 | MO | Yes |
Addresses
Primary practice location
915 N Grand Blvd
Saint Louis, MO 63106-1621
Mailing address
915 N Grand Blvd
Saint Louis, MO 63106-1621
Phone (314) 652-4100
Other names
- Jacquelynn Danielle Berumen
Other providers in Saint Louis, MO
- Dustin Kyle Baker
- Dylan Baker
- Gary Owen Baker
- Glynnis P Baker
- Haley Elise Baker
- Jada Ann Nicole Baker
- Jeffery Baker
- Jonathan Craig Baker
- Joseph Dalton Baker
- Joshua Norbert Baker
All providers in Saint Louis, MO · Physician Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.