Healthcare Provider Details

I. General information

NPI: 1629580246
Provider Name (Legal Business Name): AMY E COOLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2017
Last Update Date: 09/12/2025
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S. GRAND DOOR 3
ST. LOUIS MO
63104-6310
US

IV. Provider business mailing address

1945 CHEROKEE TRAIL LN
FLORISSANT MO
63031-7426
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-5110
  • Fax:
Mailing address:
  • Phone: 618-581-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2017038958
License Number StateMO

VII. Legacy identifiers

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

# 1
Identifier2017038958
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMISSOURI STATE BOARD OF NURSING

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: