Basic Information
| Provider Information | |||||||||
| NPI: | 1700253812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RECHTERMAN | ||||||||
| FirstName: | JONNA | ||||||||
| MiddleName: | HICKCOX | ||||||||
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| Credential: | APRN FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1502 N JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 646331948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6605421695 | ||||||||
| FaxNumber: | 6605420363 | ||||||||
| Practice Location | |||||||||
| Address1: | 1502 N JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6605421695 | ||||||||
| FaxNumber: | 6605420363 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2015 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2015026488 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 420025904 | 05 | MO | MEDICAID |