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General NPI Number Information
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NPI Number | 1689673956
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Entity Type | Individual
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Provider Name | NANCY BIRTLEY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 6209 MID RIVERS MALL DR SUITE 317
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City | SAINT PETERS
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State | MO
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Zip | 63304-1102
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Country | US
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Telephone | 636-244-4500
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Fax | 636-244-4505
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Provider Business Mailing Address
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Address Line | 6209 MID RIVERS MALL DR SUITE 317
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City | SAINT PETERS
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State | MO
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Zip | 63304-1102
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Country | US
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Telephone | 636-244-4500
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Fax | 636-244-4505
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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 | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 107603
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2015034704
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License Number State | MO
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