Provider Demographics
NPI:1023580099
Name:NGO, AMY (FNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:800-647-2098
Mailing Address - Fax:314-362-3192
Practice Address - Street 1:5225 MID AMERICA PLZ
Practice Address - Street 2:DIV IM MEDICAL ONCOLOGY, STE D115
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:800-647-2098
Practice Address - Fax:314-362-3192
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018042027363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420071650Medicaid