Healthcare Provider Details

I. General information

NPI: 1154972958
Provider Name (Legal Business Name): NICOLE MARIE BIDDINGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 N FLORISSANT AVE
SAINT LOUIS MO
63107-1812
US

IV. Provider business mailing address

4414 N FLORISSANT AVE
SAINT LOUIS MO
63107-1812
US

V. Phone/Fax

Practice location:
  • Phone: 314-814-8700
  • Fax:
Mailing address:
  • Phone: 314-814-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3136
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2024014049
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: