Healthcare Provider Details

I. General information

NPI: 1154276145
Provider Name (Legal Business Name): MUHAMMAD IDREES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WELDON SPRING PKWY
WELDON SPRING MO
63304-9101
US

IV. Provider business mailing address

909 KIEFER RIDGE DR
BALLWIN MO
63021-6098
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-7300
  • Fax:
Mailing address:
  • Phone: 314-570-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026010789
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: