Healthcare Provider Details

I. General information

NPI: 1043581556
Provider Name (Legal Business Name): COURTNEY CHAD ALAN SINGREY R.N., NP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 S BIG BEND BLVD
SAINT LOUIS MO
63117-2203
US

IV. Provider business mailing address

1423 S BIG BEND BLVD
SAINT LOUIS MO
63117-2203
US

V. Phone/Fax

Practice location:
  • Phone: 314-875-0380
  • Fax: 314-875-0382
Mailing address:
  • Phone: 314-875-0380
  • Fax: 314-875-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2005032373
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: