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JACK PARKER PETRUCCI
NPI 1407669435
Student in an Organized Health Care Education/Training Program in Saint Louis, MO

Active since January 31, 2025
1500 PARK AVE, SAINT LOUIS, MO 63104(314) 833-2758 Get Directions Write a Review

NPPES record last updated: January 31, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jack Parker Petrucci NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK PARKER PETRUCCI (NPI 1407669435) is an individual student in an organized health care education/training program in Saint Louis, Missouri and active in the NPI registry since January 2025.

NPPES Registry Identity

NPI1407669435
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJACK PARKER PETRUCCI
Location Address1500 PARK AVESaint Louis, MO 63104-3024
Mailing Address903 W Smith StKirksville, MO 63501-1674 · (614) 558-0567
Phone(314) 833-2758
Sole ProprietorNo
Enumeration DateJanuary 31, 2025
NPPES CertifiedJanuary 31, 2025
✔ NPI 1407669435 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1500 PARK AVE, Saint Louis, MO 63104
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YASMEEN FATIMA
Student in an Organized Health Care Education/Training Program
1500 PARK AVE
SAINT LOUIS, MO 63104
St. Louis City (314) 814-8700
CADEN HEATON
Student in an Organized Health Care Education/Training Program
1500 PARK AVE
SAINT LOUIS, MO 63104
St. Louis City (801) 603-1633
KATHERINE GRACE RUDDELL
Student in an Organized Health Care Education/Training Program
1500 PARK AVE
SAINT LOUIS, MO 63104
St. Louis City (314) 252-8429
IQRA AZFAR
Student in an Organized Health Care Education/Training Program
1500 PARK AVE
SAINT LOUIS, MO 63104
St. Louis City (866) 626-2878
JAMIL SEIDU
Student in an Organized Health Care Education/Training Program
1500 PARK AVE
SAINT LOUIS, MO 63104
St. Louis City (314) 833-2700
ABRAHAM A. HARAKE
Student in an Organized Health Care Education/Training Program
1500 PARK AVE
SAINT LOUIS, MO 63104
St. Louis City (734) 666-8281
FAISAL KHAN
Student in an Organized Health Care Education/Training Program
1500 PARK AVE
SAINT LOUIS, MO 63104
St. Louis City (314) 833-2700
DAKSH DESAI
Counselor (Addiction (Substance Use Disorder))
1500 PARK AVE
SAINT LOUIS, MO 63104
St. Louis City (314) 833-2700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Petrucci's NPI number?

The NPI number for Jack Petrucci is 1407669435. It was assigned to this individual provider in the NPPES registry on January 31, 2025.

Where is Jack Petrucci located?

Jack Petrucci practices at 1500 Park Ave, Saint Louis, MO 63104. The listed phone number is (314) 833-2758.

What is Jack Petrucci's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Jack Petrucci was last updated on January 31, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.