Healthcare Provider Details

I. General information

NPI: 1225827793
Provider Name (Legal Business Name): LAURA BO-KHIA NIBOH WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 HIGHLANDS PLAZA DRIVE #280
SAINT LOUIS MO
63110-1351
US

IV. Provider business mailing address

PO BOX 959354 #280
SAINT LOUIS MO
63195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-2620
  • Fax:
Mailing address:
  • Phone: 314-286-2620
  • Fax: 314-286-2621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2016017714
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025016859
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: