Provider Demographics
NPI:1629580246
Name:COOLEY, AMY E (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:COOLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1945 CHEROKEE TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7426
Mailing Address - Country:US
Mailing Address - Phone:618-581-3093
Mailing Address - Fax:
Practice Address - Street 1:1225 S. GRAND
Practice Address - Street 2:DOOR 3
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-6310
Practice Address - Country:US
Practice Address - Phone:314-977-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017038958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017038958OtherMISSOURI STATE BOARD OF NURSING