Healthcare Provider Details

I. General information

NPI: 1144672197
Provider Name (Legal Business Name): HEATHER MARIE VANNOY-STORM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER MARIE VANNOY DO

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 09/28/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12348 OLD TESSAN ROAD SUITE 160
ST. LOUIS MO
63128
US

IV. Provider business mailing address

12348 OLD TESSAN ROAD SUITE 160
ST. LOUIS MO
63128
US

V. Phone/Fax

Practice location:
  • Phone: 314-466-7380
  • Fax: 314-467-3801
Mailing address:
  • Phone: 314-467-3800
  • Fax: 314-467-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2016018721
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019024030
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: