Healthcare Provider Details

I. General information

NPI: 1366597809
Provider Name (Legal Business Name): PEGGY A WAHLIG-WEHKING ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-6376
  • Fax: 314-367-0225
Mailing address:
  • Phone: 314-289-6376
  • Fax: 314-367-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2013040393
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: