Provider Demographics
NPI:1467453134
Name:CARMODY, CHERI M (RN BC ANP)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:M
Last Name:CARMODY
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Gender:F
Credentials:RN BC ANP
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Mailing Address - Street 1:121 SAINT LUKES CENTER DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3518
Mailing Address - Country:US
Mailing Address - Phone:314-529-4900
Mailing Address - Fax:314-251-6177
Practice Address - Street 1:121 SAINT LUKES CENTER DR
Practice Address - Street 2:SUITE 406
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3518
Practice Address - Country:US
Practice Address - Phone:314-529-4900
Practice Address - Fax:314-251-6177
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-04-13
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Provider Licenses
StateLicense IDTaxonomies
MO146843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P92397Medicare UPIN