Provider Demographics
NPI:1013214576
Name:BICIOCCHI, MISTY D (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:D
Last Name:BICIOCCHI
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8056-0918-01
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:618-463-7323
Mailing Address - Fax:314-286-2505
Practice Address - Street 1:4 MEMORIAL DR
Practice Address - Street 2:STE 134
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6705
Practice Address - Country:US
Practice Address - Phone:618-607-1340
Practice Address - Fax:618-622-9724
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2023-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209008627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420040667Medicaid