Provider Demographics
NPI:1841287067
Name:OCONNOR, CARMEN M (APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:M
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:M
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-842-0602
Mailing Address - Fax:314-842-4372
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-842-0602
Practice Address - Fax:314-842-4372
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133519363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428735603Medicaid
MO156440013Medicare PIN
MOQ15894Medicare UPIN