Individual
GARY PAUL QUILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP
Contact information
Practice address
1068 S WOODS MILL RD STE 220, TOWN AND COUNTRY, MO 63017-8333
(314) 394-1379
(314) 394-1377
Mailing address
1068 S WOODS MILL RD STE 220, TOWN AND COUNTRY, MO 63017-8333
(314) 394-1379
(314) 394-1377
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
AG1014022
MO
363LG0600X
Gerontology Nurse Practitioner
Primary
AG1014022
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861895013
—
MO
Enumeration date
10/02/2014
Last updated
09/24/2019
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