Healthcare Provider Details

I. General information

NPI: 1407710627
Provider Name (Legal Business Name): AMY DANNEMILLER VYN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S NEW BALLAS RD
SAINT LOUIS MO
63141-8702
US

IV. Provider business mailing address

1204 SIMMONS AVE
KIRKWOOD MO
63122-1113
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6710
  • Fax:
Mailing address:
  • Phone: 513-967-8537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025028267
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: