Provider Demographics
NPI:1700597531
Name:VINING, ANNIE LAURIE (DNP, WHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:LAURIE
Last Name:VINING
Suffix:
Gender:F
Credentials:DNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHESTERFIELD CTR STE 250
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4833
Mailing Address - Country:US
Mailing Address - Phone:636-519-8889
Mailing Address - Fax:
Practice Address - Street 1:500 CHESTERFIELD CTR STE 250
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4833
Practice Address - Country:US
Practice Address - Phone:636-519-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008002029363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health