Healthcare Provider Details

I. General information

NPI: 1366988891
Provider Name (Legal Business Name): THERESA JOY HASTING WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 01/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD 1400
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

1727 HIGHVIEW CIRCLE CT
BALLWIN MO
63021-7806
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-7955
  • Fax:
Mailing address:
  • Phone: 314-598-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2016042957
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: