Provider Demographics
NPI:1922668052
Name:POLTER, YOCHEVED JUDY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:YOCHEVED
Middle Name:JUDY
Last Name:POLTER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:YOCHEVED
Other - Middle Name:JUDY
Other - Last Name:WITTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8347 DELMAR BLVD APT 1S
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2150
Mailing Address - Country:US
Mailing Address - Phone:347-229-5226
Mailing Address - Fax:
Practice Address - Street 1:6744 CLAYTON RD STE 305
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1639
Practice Address - Country:US
Practice Address - Phone:314-274-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017008882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily