Healthcare Provider Details

I. General information

NPI: 1639686611
Provider Name (Legal Business Name): MICHAEL JOSEPH ZAPPULLA AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BJC SAINT PETERS DR STE 100
SAINT PETERS MO
63376-3386
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-916-7233
  • Fax:
Mailing address:
  • Phone: 636-916-7233
  • Fax: 636-916-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017044247
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: