Individual
VICKIE JOANN CARLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
6420 CLAYTON RD, SAINT LOUIS, MO 63117-1811
(314) 317-0600
(314) 317-0606
Mailing address
12125 WOODCREST EXECUTIVE DR, SUITE 220, SAINT LOUIS, MO 63141-5001
(314) 317-0600
(314) 317-0606
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
109547
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710902176
—
MO
Enumeration date
07/13/2006
Last updated
08/15/2013
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