MEDICARE: DR. TERESA LYNNE BAUER DNP

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	363L00000X	Nurse Practitioner	209035026	IL
2	363LA2200X	Adult Health Nurse Practitioner	2022042404	MO
3	363LG0600X	Gerontology Nurse Practitioner	2022042404	MO

General Provider Information

NPI Number	:	1295446706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA LYNNE BAUER DNP

Provider Business Mailing Address
First Line	:	PO BOX 959203
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-9203
Country	:	US
Telephone Number	:	618-257-6480
Fax Number	:	618-235-2620

Provider Business Practice Location Address
First Line	:	4700 MEMORIAL DRIVE STE 250
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-0001
Country	:	US
Telephone Number	:	618-257-6480
Fax Number	:	618-235-2620

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

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	03/17/2026

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