Healthcare Provider Details

I. General information

NPI: 1285443291
Provider Name (Legal Business Name): NYA NICOLE HUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12380 DE PAUL DR, BRIDGETON, MO
SAINT LOUIS MO
63044-2512
US

IV. Provider business mailing address

2901 UNIVERSITY MEADOWS DR
SAINT LOUIS MO
63121-4600
US

V. Phone/Fax

Practice location:
  • Phone: 314-447-9700
  • Fax: 717-547-8956
Mailing address:
  • Phone: 217-553-9846
  • Fax: 217-553-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: