MEDICARE: NYA NICOLE HUNTER

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1285443291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYA NICOLE HUNTER

Provider Business Mailing Address
First Line	:	2901 UNIVERSITY MEADOWS DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4600
Country	:	US
Telephone Number	:	217-553-9846
Fax Number	:	217-553-9846

Provider Business Practice Location Address
First Line	:	12380 DE PAUL DR, BRIDGETON, MO
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63044-2512
Country	:	US
Telephone Number	:	314-447-9700
Fax Number	:	717-547-8956

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

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	01/03/2025

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Directions to “ NYA NICOLE HUNTER ” Practice Location

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