Healthcare Provider Details

I. General information

NPI: 1366781734
Provider Name (Legal Business Name): COURTNEY A BRUSH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY BRUSH FNP

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 KEHRS MILL RD
BALLWIN MO
63011-3232
US

IV. Provider business mailing address

566 KEHRS MILL RD
BALLWIN MO
63011-3232
US

V. Phone/Fax

Practice location:
  • Phone: 314-971-3130
  • Fax:
Mailing address:
  • Phone: 314-971-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number2016000450
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2012005844
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2012005844
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: