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General NPI Number Information
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NPI Number | 1568312023
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Entity Type | Individual
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Provider Name | JUSTIN RAY LOVELADY PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 5700 MEXICO RD STE 8
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City | SAINT PETERS
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State | MO
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Zip | 63376-1667
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Country | US
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Telephone | 636-447-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 3945 WALSH ST
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City | SAINT LOUIS
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State | MO
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Zip | 63116-3369
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Country | US
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Telephone | 636-485-0957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2026004945
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License Number State | MO
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