Healthcare Provider Details

I. General information

NPI: 1326608241
Provider Name (Legal Business Name): ANNA HARPER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12348 OLD TESSON RD STE 160
SAINT LOUIS MO
63128-2251
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 314-467-3800
  • Fax: 314-467-3801
Mailing address:
  • Phone: 314-364-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201912524
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: