Healthcare Provider Details

I. General information

NPI: 1881044402
Provider Name (Legal Business Name): CANDACE SUE COUNTS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD STE 210
SAINT LOUIS MO
63124
US

IV. Provider business mailing address

8888 LADUE RD STE 210
SAINT LOUIS MO
63124-2056
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5900
  • Fax: 314-996-5910
Mailing address:
  • Phone: 314-996-5900
  • Fax: 314-996-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016019106
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: