Healthcare Provider Details

I. General information

NPI: 1982262580
Provider Name (Legal Business Name): NICHOLE MICHELLE BAUMGARTNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

6 PAR CT
HIGH RIDGE MO
63049-3526
US

V. Phone/Fax

Practice location:
  • Phone: 314-807-3105
  • Fax:
Mailing address:
  • Phone: 314-807-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06192192
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: