MEDICARE: DR. JOHN NANNEY PH.D.

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	103TC0700X	Clinical Psychologist	1248	LA
2	103TC0700X	Clinical Psychologist	2014023811	MO

General Provider Information

NPI Number	:	1992126924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN NANNEY PH.D.

Provider Business Mailing Address
First Line	:	102 TURF CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-4622
Country	:	US
Telephone Number	:	314-599-1595
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 TURF CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-4622
Country	:	US
Telephone Number	:	314-599-1595
Fax Number	:

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

Provider Enumeration Date	:	12/17/2013
Last Update Date	:	06/01/2023

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Directions to “ DR. JOHN NANNEY PH.D.” Practice Location

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