Healthcare Provider Details

I. General information

NPI: 1720745342
Provider Name (Legal Business Name): ANDIE MICHELLE DORRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKVIEW PL
SAINT LOUIS MO
63110-1038
US

IV. Provider business mailing address

1717 OLIVE ST APT 628
SAINT LOUIS MO
63103-1781
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-3000
  • Fax:
Mailing address:
  • Phone: 423-987-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG05260005
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: