Healthcare Provider Details

I. General information

NPI: 1922295633
Provider Name (Legal Business Name): LAURIE ANN HEAPS APRN, BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8710 MANCHESTER RD
SAINT LOUIS MO
63144-2724
US

IV. Provider business mailing address

PO BOX 157 110 SOUTH 2ND STREET
ELLINGTON MO
63638-0157
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-3570
  • Fax:
Mailing address:
  • Phone: 573-663-2313
  • Fax: 573-663-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107193
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: