Healthcare Provider Details

I. General information

NPI: 1184895690
Provider Name (Legal Business Name): CHRISTY MARIE DYER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 HIGHWAY K
O FALLON MO
63368-7861
US

IV. Provider business mailing address

3938 RHINE CT
SAINT CHARLES MO
63304-1465
US

V. Phone/Fax

Practice location:
  • Phone: 866-825-3227
  • Fax:
Mailing address:
  • Phone: 636-939-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number079499
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: