Healthcare Provider Details

I. General information

NPI: 1881289510
Provider Name (Legal Business Name): ALEXANDER STEIN DAVIS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 OLIVE ST
SAINT LOUIS MO
63103-1489
US

IV. Provider business mailing address

2650 OLIVE ST
SAINT LOUIS MO
63103-1489
US

V. Phone/Fax

Practice location:
  • Phone: 314-371-6500
  • Fax: 314-371-6510
Mailing address:
  • Phone: 314-371-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2021004960
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021004960
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: