Provider Demographics
NPI:1629304977
Name:KOONCE, DANIELLE S (PNP)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:S
Last Name:KOONCE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6000
Mailing Address - Fax:314-747-3338
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED EMERGENCY MED
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6000
Practice Address - Fax:314-747-3338
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009033160363LP0200X
MO143443363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429449804Medicaid
P00789107OtherRAILROAD MEDICARE
MO1629304977Medicaid
MO132300089Medicare PIN