Individual
STACY L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
255 SPENCER RD STE 201, SAINT PETERS, MO 63376-2576
(636) 939-2550
Mailing address
751 JONATHAN CODY DR, WENTZVILLE, MO 63385-6877
(314) 608-5726
(314) 842-2552
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2018018396
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2020034563
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
363LP0808X
TAXONOMY
—
05
—
420064105
—
MO
Enumeration date
08/09/2018
Last updated
07/22/2024
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