Provider Demographics
NPI:1033417639
Name:CRESWELL, ALLISON MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MARIE
Last Name:CRESWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:NOELKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 297A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6364
Mailing Address - Fax:314-251-7897
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 297A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6364
Practice Address - Fax:314-251-7897
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012042656363AS0400X
IL085003993363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical