MEDICARE: MS. MISTY D WHEELOCK ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	142467	MO

General Provider Information

NPI Number	:	1073700217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MISTY D WHEELOCK ANP

Provider Business Mailing Address
First Line	:	10050 KENNERLY RD STE 2400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2193
Country	:	US
Telephone Number	:	314-849-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	10050 KENNERLY RD STE 2400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2193
Country	:	US
Telephone Number	:	314-849-6066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	06/24/2024

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