Healthcare Provider Details

I. General information

NPI: 1033659859
Provider Name (Legal Business Name): ELIZABETH SHIPP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MAPLEWOOD COMMONS DR
SAINT LOUIS MO
63143-1003
US

IV. Provider business mailing address

2015 MAPLEWOOD COMMONS DR
SAINT LOUIS MO
63143-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-293-4023
  • Fax: 314-293-4285
Mailing address:
  • Phone: 314-293-4023
  • Fax: 314-293-4285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017013397
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016034064
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2017013397
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: