=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720512551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. BRITTANY RYAN STAPLES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2017
-----------------------------------------------------
Last Update Date | 08/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11709 OLD BALLAS RD STE 201
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-432-5683
-----------------------------------------------------
Fax | 314-997-7212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11709 OLD BALLAS RD STE 201
-----------------------------------------------------
City | CREVE COEUR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63141-7029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-432-5683
-----------------------------------------------------
Fax | 314-997-7212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 2020011180
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------