Provider Demographics
NPI:1619196797
Name:BINGHAM, MINDY KAY (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:KAY
Last Name:BINGHAM
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Gender:F
Credentials:APRN, BC
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Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-653-5484
Mailing Address - Fax:314-653-5483
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:STE 406
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-653-5484
Practice Address - Fax:314-653-5483
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2013-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL309-002288363LA2200X
MO119797363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health