Provider Demographics
NPI:1841255452
Name:DEADY, MARTHA HURST (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:HURST
Last Name:DEADY
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:3042 JAMIE CT
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2573
Mailing Address - Country:US
Mailing Address - Phone:636-282-0951
Mailing Address - Fax:
Practice Address - Street 1:JOHN COCHRAN VAMC 915 NORTH GRAND AVE.
Practice Address - Street 2:11FJC
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-289-7612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO113743363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical