Healthcare Provider Details

I. General information

NPI: 1669094900
Provider Name (Legal Business Name): COURTNEY A BEQUETTE FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2020
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 HAZEL LN
FARMINGTON MO
63640-1999
US

IV. Provider business mailing address

PO BOX 957683
SAINT LOUIS MO
63195-7683
US

V. Phone/Fax

Practice location:
  • Phone: 573-573-7566
  • Fax: 573-760-8044
Mailing address:
  • Phone: 573-756-6751
  • Fax: 573-760-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017042346
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: