Healthcare Provider Details

I. General information

NPI: 1629913033
Provider Name (Legal Business Name): TAMMY POWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SUGAR VALLEY CT
SAINT PETERS MO
63376-7454
US

IV. Provider business mailing address

805 SUGAR VALLEY CT
SAINT PETERS MO
63376-7454
US

V. Phone/Fax

Practice location:
  • Phone: 314-413-0374
  • Fax:
Mailing address:
  • Phone: 314-413-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberGL26-000713
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: