Healthcare Provider Details

I. General information

NPI: 1053359281
Provider Name (Legal Business Name): ALLISON GRACE TUTTLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON GRACE LYNDS

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S. NEW BALLAS RD MERCY HOSPITAL ST. LOUIS
ST. LOUIS MO
63141
US

IV. Provider business mailing address

621 S. NEW BALLAS RD. MIDWEST SPINE SURGEONS
ST. LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6000
  • Fax:
Mailing address:
  • Phone: 314-251-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2006006981
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: