Provider Demographics
NPI:1073700217
Name:WHEELOCK, MISTY D (ANPP)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:D
Last Name:WHEELOCK
Suffix:
Gender:F
Credentials:ANPP
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Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:845 N NEW BALLAS CT
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7134
Practice Address - Country:US
Practice Address - Phone:314-983-4700
Practice Address - Fax:314-692-9862
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2019-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO142467163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO816352295Medicare PIN
MOP92399Medicare UPIN