Individual
MISTY DAWN BIRNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
12660 LAMPLIGHTER SQR SHPPNG CTR, SUITE J, SAINT LOUIS, MO 63128-2761
(314) 394-1379
(314) 394-1377
Mailing address
12660 LAMPLIGHTER SQR SHPPNG CTR, J, SAINT LOUIS, MO 63128-2761
(314) 394-1379
(314) 394-1377
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2010041400
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150770001
MEDICARE PTAN
MO
Enumeration date
12/14/2010
Last updated
05/15/2012
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