MEDICARE: MRS. LEXXIE S. GRAMKE PMHNP-BC, AGPCNP-BC

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	2014040185	MO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2014040185	MO

General Provider Information

NPI Number	:	1982002812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEXXIE S. GRAMKE PMHNP-BC, AGPCNP-BC

Provider Business Mailing Address
First Line	:	11116 S TOWNE SQ STE 205
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7809
Country	:	US
Telephone Number	:	314-567-1958
Fax Number	:

Provider Business Practice Location Address
First Line	:	11116 S TOWNE SQ STE 205
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7809
Country	:	US
Telephone Number	:	314-567-1958
Fax Number	:

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

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	11/04/2020

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