Provider Demographics
NPI:1811548035
Name:FAULSTICH, AUDREY (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:FAULSTICH
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 LOCKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2722
Mailing Address - Country:US
Mailing Address - Phone:314-602-7340
Mailing Address - Fax:
Practice Address - Street 1:925 MADISON AVE FRNT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IL
Practice Address - Zip Code:62060-1316
Practice Address - Country:US
Practice Address - Phone:314-602-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020154363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health