Healthcare Provider Details

I. General information

NPI: 1194369884
Provider Name (Legal Business Name): LINDSAY D GWALTNEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 07/20/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV IM ENDOCRINOLOGY
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8127
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3500
  • Fax: 314-362-3454
Mailing address:
  • Phone: 314-362-3500
  • Fax: 314-362-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020039937
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: