Healthcare Provider Details

I. General information

NPI: 1396659413
Provider Name (Legal Business Name): HESPERIN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 N TAYLOR AVE
SAINT LOUIS MO
63108-1888
US

IV. Provider business mailing address

536 N TAYLOR AVE
SAINT LOUIS MO
63108-1888
US

V. Phone/Fax

Practice location:
  • Phone: 314-449-1143
  • Fax: 314-449-1724
Mailing address:
  • Phone: 314-449-1143
  • Fax: 314-449-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ONYEMA NNANNA
Title or Position: OWNER
Credential: MD
Phone: 617-982-8328