Healthcare Provider Details

I. General information

NPI: 1992161210
Provider Name (Legal Business Name): AMY L THAYER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY PYTLINSKI NP

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N BALLAS RD STE C-45
SAINT LOUIS MO
63131-2321
US

IV. Provider business mailing address

2821 N BALLAS RD STE C-45
SAINT LOUIS MO
63131-2321
US

V. Phone/Fax

Practice location:
  • Phone: 314-918-5508
  • Fax: 314-918-5052
Mailing address:
  • Phone: 314-918-5508
  • Fax: 314-918-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015044896
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: