Healthcare Provider Details

I. General information

NPI: 1275304974
Provider Name (Legal Business Name): AMY ELIZABETH GEMMELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS RD
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

1 JEFFERSON BARRACKS RD
SAINT LOUIS MO
63125-4181
US

V. Phone/Fax

Practice location:
  • Phone: 314-894-6654
  • Fax: 314-894-5775
Mailing address:
  • Phone: 314-894-6654
  • Fax: 314-894-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2017009668
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: