Healthcare Provider Details

I. General information

NPI: 1558218529
Provider Name (Legal Business Name): LANA FAYE FELLHOELTER WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

864 SW 201 RD
DEEPWATER MO
64740-9743
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2026005087
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: