Healthcare Provider Details

I. General information

NPI: 1609234871
Provider Name (Legal Business Name): DAWN SHONTELL PATRICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 N FLORISSANT RD
FERGUSON MO
63135-1976
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 314-449-9640
  • Fax: 314-949-3437
Mailing address:
  • Phone: 888-987-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016001341
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: