Provider Demographics
NPI:1982002812
Name:GRAMKE, LEXXIE S (PMHNP-BC, AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LEXXIE
Middle Name:S
Last Name:GRAMKE
Suffix:
Gender:F
Credentials:PMHNP-BC, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 S TOWNE SQ STE 205
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7809
Mailing Address - Country:US
Mailing Address - Phone:314-567-1958
Mailing Address - Fax:
Practice Address - Street 1:11116 S TOWNE SQ STE 205
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7809
Practice Address - Country:US
Practice Address - Phone:314-567-1958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014040185363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health