Provider Demographics
NPI:1710005236
Name:WEST, STEPHANIE LEE ANN (ANP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEE ANN
Last Name:WEST
Suffix:
Gender:F
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8056
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:800-647-2098
Mailing Address - Fax:314-362-3192
Practice Address - Street 1:1255 GRAHAM RD
Practice Address - Street 2:DIV IM MEDICAL ONCOLOGY, STE 101
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8014
Practice Address - Country:US
Practice Address - Phone:800-647-2098
Practice Address - Fax:314-362-3192
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2014030073363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420025134Medicaid