Provider Demographics
NPI:1316303993
Name:PEAD, GWEN C (NP)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:C
Last Name:PEAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:CHERYL
Other - Last Name:EASTEP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 505673
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3825 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3344
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035302363LF0000X
MN12610363LF0000X
IN71016811A363LF0000X
LA243022363LF0000X
ARA004700363LF0000X
TX1214124363LF0000X
AK231706363LF0000X
IL209031731363LF0000X
ID9271364363LF0000X
MO2014032347363LF0000X
COC-APN.0104333-C-NP363LF0000X
MI4704431550363LF0000X
HIAPRN-4976363LF0000X
IAA184454363LF0000X
AZ323364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily