Healthcare Provider Details

I. General information

NPI: 1255756961
Provider Name (Legal Business Name): AMY KRIEG MOSMAN MMS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LEEANN KRIEG MMS, PA-C

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 JUNGERMANN CIR STE 302
SAINT PETERS MO
63376-1637
US

IV. Provider business mailing address

70 JUNGERMANN CIR STE 302
SAINT PETERS MO
63376-1637
US

V. Phone/Fax

Practice location:
  • Phone: 636-720-0310
  • Fax: 636-720-0311
Mailing address:
  • Phone: 636-720-0310
  • Fax: 636-720-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2014006318
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: