Healthcare Provider Details

I. General information

NPI: 1942766258
Provider Name (Legal Business Name): ASHLEY M ADAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5034 GRIFFIN RD
SAINT LOUIS MO
63128-3418
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-7333
  • Fax: 314-843-9946
Mailing address:
  • Phone: 314-851-1000
  • Fax: 314-851-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019005050
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: