Healthcare Provider Details

I. General information

NPI: 1811028608
Provider Name (Legal Business Name): ST.LOUIS PEDIATRIC PRACTITIONERS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 N KINGSHIGHWAY BLVD SUITE 210
SAINT LOUIS MO
63115-1736
US

IV. Provider business mailing address

3737 N KINGSHIGHWAY BLVD SUITE 210
SAINT LOUIS MO
63115-1736
US

V. Phone/Fax

Practice location:
  • Phone: 314-261-5250
  • Fax: 314-261-4567
Mailing address:
  • Phone: 314-261-5250
  • Fax: 314-261-4567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISON CAROLE NASH
Title or Position: PRESIDENT
Credential: MD
Phone: 314-261-5250