Provider Demographics
NPI:1629375886
Name:BERNINGER, JULIE TIEDEMAN (PNP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:TIEDEMAN
Last Name:BERNINGER
Suffix:
Gender:F
Credentials:PNP
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:STE 6110, MSC 8235-49-6110
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6022
Mailing Address - Fax:314-454-2442
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV SURG PED, STE 2A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6022
Practice Address - Fax:314-454-2442
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2010039286363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425597309Medicaid
MO1629375886Medicaid