Individual
COLBY ANDREW STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
751 SAPPINGTON BRIDGE RD, SULLIVAN, MO 63080-2354
(573) 468-4186
Mailing address
660 MASON RIDGE CENTER DR STE 300, SAINT LOUIS, MO 63141-8512
(618) 463-8500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2024000101
MO
363LA2100X
Acute Care Nurse Practitioner
2024000101
MO
Other
Enumeration date
01/04/2024
Last updated
09/19/2025
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