Provider Demographics
NPI:1033460324
Name:BYRD, ANN MARIE (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BYRD
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15838 FOUNTAIN PLAZA DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7469
Mailing Address - Country:US
Mailing Address - Phone:636-484-5277
Mailing Address - Fax:
Practice Address - Street 1:15838 FOUNTAIN PLAZA DR STE A
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7469
Practice Address - Country:US
Practice Address - Phone:636-484-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012027234363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01031413OtherRAILROAD MEDICARE
MO1033460324Medicaid
MOP01031413OtherRAILROAD MEDICARE