Healthcare Provider Details

I. General information

NPI: 1275568628
Provider Name (Legal Business Name): PATRICIA EDWARDS-PARRISH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JENNINGS STATION RD 3923 SUNNYVALE CT
SAINT LOUIS MO
63121-3323
US

IV. Provider business mailing address

4000 JENNINGS STATION RD 3923 SUNNYVALE CT
SAINT LOUIS MO
63121-3323
US

V. Phone/Fax

Practice location:
  • Phone: 314-679-7800
  • Fax:
Mailing address:
  • Phone: 314-679-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number079333
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: