Provider Demographics
NPI:1073700217
Name:WHEELOCK, MISTY D (ANP)
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:D
Last Name:WHEELOCK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10050 KENNERLY RD STE 2400
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2193
Mailing Address - Country:US
Mailing Address - Phone:314-849-6066
Mailing Address - Fax:
Practice Address - Street 1:10050 KENNERLY RD STE 2400
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2193
Practice Address - Country:US
Practice Address - Phone:314-849-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142467363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO816352295Medicare PIN
MOP92399Medicare UPIN