Individual
STACIE MICHELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-ACHPN
Contact information
Practice address
621 S NEW BALLAS RD STE 6017B, SAINT LOUIS, MO 63141-8274
(314) 251-7840
Mailing address
621 S NEW BALLAS RD STE 6017B, SAINT LOUIS, MO 63141-8274
(314) 251-7840
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2019006496
MO
363LG0600X
Gerontology Nurse Practitioner
Primary
2019006496
MO
Other
Enumeration date
04/15/2019
Last updated
02/20/2026
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