JACOB BAST (NPI# 1194296186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194296186 |
| Entity Type | Individual |
| Full Name | JACOB BAST |
| Practice Address |
10010 Kennerly Rd Saint Louis MO 63128-2106 |
| Mailing Address |
6439 Fordyce Bluffs Dr Saint Louis MO 63129-5062 |
| Practice Telephone | 3145251000 |
| Mailing Telephone | 3149336577 |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2020-03-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
2020005531 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6439 Fordyce Bluffs Dr, Saint Louis, MO 631295062 | 3149336577 |
| Street Address |
10010 KENNERLY RD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63128-2106 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659374908 | Udayshanker Kasinadhuni | Anesthesiology | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2005-05-31 |
| 1598376287 | Laura Mayer | Dietitian, Registered | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-08-14 |
| 1265042014 | Caitlin E Wagner | Anesthesiologist Assistant | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-08-06 |
| 1881215424 | Samantha Broughton | Nurse Practitioner | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-05-06 |
| 1437779444 | Kathleen Stebe | Physical Therapist | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-04-20 |
| 1073148052 | Carly Pruemer | Nurse Anesthetist, Certified Registered | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-03-10 |
| 1568097541 | Altan Halici | Nurse Anesthetist, Certified Registered | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-03-10 |
| 1326673310 | Rhyz Wilson | Nurse Anesthetist, Certified Registered | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-03-10 |
| 1669007654 | Megan Hahn | Nurse Anesthetist, Certified Registered | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-03-10 |
| 1851925085 | Katie Walsh | Nurse Practitioner | 10010 Kennerly Rd, Saint Louis, MO 63128-2106 | 2020-02-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771155 | James T Fetsch Dmd LLC | Dentist | 10004 Kennerly Rd Suite 240, Saint Louis, MO 63128 | 2019-10-11 |
| 1326504655 | Nikodem Dental Holdings | Dentist | 4337 Butler Hill Rd Suite G, St Louis Mo, MO 63128 | 2019-02-12 |
| 1932678505 | Michelle Anne Arvidson | Physical Therapy Assistant | Elite Physical Therapy, 12608 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2018-11-13 |
| 1245726710 | Kristen Rider | Nurse Practitioner | 9964 Kennerly Rd Ste D, Saint Louis, MO 63128 | 2018-07-07 |
| 1306217427 | Sophia Bednarski | Dentist | 12660 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2015-10-15 |
| 1427434224 | Darcie Burrus | Counselor | 12523 Old Tesson Rd G, St Louis, MO 63128 | 2015-08-04 |
| 1710368584 | Sara Hawatmeh | Internal Medicine | 12345 W Bend Dr Ste 304, Saint Louis, MO 63128 | 2015-06-17 |
| 1871989590 | Celia Grace Montes-kolence | Speech-Language Pathologist | 12335 W Bend Drive, Saint Louis, MO 63128 | 2015-04-09 |
| 1245629302 | Marius Antonio Evans | Dentist | 9911 Kennerly Rd., Suite G, St. Louis, MO 63128 | 2015-01-13 |
| 1801230313 | Sarah Elizabeth Walsh | Emergency Medicine | 10010 Kennerly Road, Emergency Department, St. Anthony's Medical Center, St. Louis, MO 63128 | 2013-04-26 |
| Find all providers in zip 63128 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891227393 | Hollis Smith | Physician Assistant | 2015 Maplewood Commons Dr, Saint Louis, MO 63143-1003 | 2017-04-03 |
| 1649397894 | Rachel S Tarr | Physician Assistant | 2208 Richert Pl, Saint Louis, MO 63143-2522 | 2007-03-23 |
| 1528198439 | Jonathan Adam Pellechia | Physician Assistant | 11155 Dunn Rd Ste 315e, Saint Louis, MO 63136-6111 | 2007-03-07 |
| 1376174417 | Robert Cory Proffer | Physician Assistant | 607 S New Ballas Rd Ste 2300, Saint Louis, MO 63141-8234 | 2020-01-28 |
| 1881246502 | Ariel Ashley Schnell | Physician Assistant | 3655 Vista Ave, Saint Louis, MO 63110-2539 | 2019-07-12 |
| 1508335779 | Gerard Forster | Physician Assistant | 12647 Olive Blvd Ste 600, Saint Louis, MO 63141-6346 | 2018-11-17 |
| 1124509773 | Sara Burke Connolly | Physician Assistant | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2018-08-22 |
| 1831675545 | Kyle Patrick Mclafferty | Physician Assistant | 11133 Dunn Rd, Saint Louis, MO 63136-6163 | 2018-07-16 |
| 1649768995 | Paul Thomas Mrotek | Physician Assistant | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2018-04-23 |
| 1568967628 | Megan Moseley | Physician Assistant | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2018-03-29 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63128 |
Please comment or provide details below to improve the information on JACOB BAST.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.