Healthcare Provider Details

I. General information

NPI: 1982002812
Provider Name (Legal Business Name): LEXXIE S. GRAMKE PMHNP-BC, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 S TOWNE SQ STE 205
SAINT LOUIS MO
63123-7809
US

IV. Provider business mailing address

11116 S TOWNE SQ STE 205
SAINT LOUIS MO
63123-7809
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-1958
  • Fax:
Mailing address:
  • Phone: 314-567-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2014040185
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2014040185
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: