Healthcare Provider Details

I. General information

NPI: 1336221852
Provider Name (Legal Business Name): LINDA K MCCLOUD ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD SUITE 304
ST LOUIS MO
63136
US

IV. Provider business mailing address

3 BARLEY DR
TROY IL
62294
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-1166
  • Fax: 314-355-9179
Mailing address:
  • Phone: 618-667-0836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number098637
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209001076
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: