Provider Demographics
NPI:1306345624
Name:SUMMERS, STEPHANIE RAE (MSN-FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RAE
Other - Last Name:THESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN-FNP
Mailing Address - Street 1:11125 DUNN RD STE 406
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-653-5484
Mailing Address - Fax:
Practice Address - Street 1:11125 DUNN RD STE 406
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-653-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018003302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily