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NPI Code Detail

MEDICARE: STEPHEN WALTER PITCHFORD FNP-C

MEDICARE: STEPHEN WALTER PITCHFORD FNP-C
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
1163W00000XRegistered Nurse2009003957MO
2363LF0000XFamily Nurse Practitioner2016019534MO

General Provider Information

NPI Number : 1588181051
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN WALTER PITCHFORD FNP-C
Provider Business Mailing Address
First Line : 739 MONTEGO DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63126-1429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3200 CHOUTEAU AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-2910
Country : US
Telephone Number : 314-977-1250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2017
Last Update Date : 08/25/2017

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Directions to “ STEPHEN WALTER PITCHFORD FNP-C” Practice Location

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