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General NPI Number Information
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NPI Number | 1033070115
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Entity Type | Organization
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Legal Business Name | PRAIRIE SUN PSYCHIATRY, LLC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 4401 CHOUTEAU AVE APT 2207
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1604
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Country | US
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Telephone | 402-591-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 4401 CHOUTEAU AVE APT 2207
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1604
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Country | US
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Telephone | 402-591-9460
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Fax |
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Authorized Official
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Title or Position | DR
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Name | THAO NGUYEN BUI
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Credential |
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Telephone | 402-591-9460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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