Healthcare Provider Details

I. General information

NPI: 1689673956
Provider Name (Legal Business Name): NANCY BIRTLEY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6209 MID RIVERS MALL DR SUITE 317
SAINT PETERS MO
63304-1102
US

IV. Provider business mailing address

6209 MID RIVERS MALL DR SUITE 317
SAINT PETERS MO
63304-1102
US

V. Phone/Fax

Practice location:
  • Phone: 636-244-4500
  • Fax: 636-244-4505
Mailing address:
  • Phone: 636-244-4500
  • Fax: 636-244-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number107603
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2015034704
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: