Provider Demographics
NPI:1881871432
Name:ADVANCED PRACTICE PROVIDERS
Entity type:Organization
Organization Name:ADVANCED PRACTICE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:314-623-0238
Mailing Address - Street 1:2500 JESSICA CT
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-3227
Mailing Address - Country:US
Mailing Address - Phone:314-623-0238
Mailing Address - Fax:
Practice Address - Street 1:2500 JESSICA CT
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-3227
Practice Address - Country:US
Practice Address - Phone:314-623-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149967363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000014317Medicare PIN