Provider Demographics
NPI:1316780448
Name:BURNS, STEPHANIE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 WESINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-4134
Mailing Address - Country:US
Mailing Address - Phone:618-334-0466
Mailing Address - Fax:
Practice Address - Street 1:2706 S RIVER RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5936
Practice Address - Country:US
Practice Address - Phone:314-631-4299
Practice Address - Fax:314-631-4316
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024025570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health