MEDICARE: LAUREN M TRIPP NP-C

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	363LF0000X	Family Nurse Practitioner	2016013310	MO

General Provider Information

NPI Number	:	1124574090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN M TRIPP NP-C

Provider Business Mailing Address
First Line	:	737 LOST CANYON BLVD
Second Line	:
City	:	WENTZVILLE
State	:	MO
Zip	:	63385-3816
Country	:	US
Telephone Number	:	314-477-2361
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 W HIGHWAY D STE 201
Second Line	:
City	:	NEW MELLE
State	:	MO
Zip	:	63365-1019
Country	:	US
Telephone Number	:	636-206-6144
Fax Number	:

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	12/01/2023

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