MEDICARE: HEATHER S ROUTH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2024008617	MO

General Provider Information

NPI Number	:	1013743681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER S ROUTH FNP

Provider Business Mailing Address
First Line	:	1 BARNES JEWISH HOSPITAL PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1003
Country	:	US
Telephone Number	:	314-906-2544
Fax Number	:	314-747-7253

Provider Business Practice Location Address
First Line	:	1 BARNES JEWISH HOSPITAL PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1003
Country	:	US
Telephone Number	:	314-906-2544
Fax Number	:	314-747-7253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	12/15/2025

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