Healthcare Provider Details

I. General information

NPI: 1295299295
Provider Name (Legal Business Name): CIERRA CROWLEY CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1216 CLAYCREST DR
SAINT CHARLES MO
63304-3497
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5335
  • Fax:
Mailing address:
  • Phone: 636-584-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2019002362
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: