Provider Demographics
NPI:1831390772
Name:BAYER, AGNES ELISABETH (CPNP)
Entity type:Individual
Prefix:MS
First Name:AGNES
Middle Name:ELISABETH
Last Name:BAYER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7387 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4405
Mailing Address - Country:US
Mailing Address - Phone:314-500-5437
Mailing Address - Fax:314-500-5683
Practice Address - Street 1:7387 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119
Practice Address - Country:US
Practice Address - Phone:314-500-5437
Practice Address - Fax:314-500-5683
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018040896163W00000X
NY479405-1163W00000X
TX706774363L00000X
NYF381465363LP0200X
TXAP124482363LP0200X
MO2018011775363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01976989Medicaid