Healthcare Provider Details

I. General information

NPI: 1427914795
Provider Name (Legal Business Name): REBECCA ANNE MARIE WEST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 MATTOX DR
SULLIVAN MO
63080-2365
US

IV. Provider business mailing address

PO BOX 959318
SAINT LOUIS MO
63195-9318
US

V. Phone/Fax

Practice location:
  • Phone: 573-860-6000
  • Fax: 573-860-6016
Mailing address:
  • Phone: 573-860-6000
  • Fax: 573-860-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025054149
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025054149
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: