Provider Demographics
NPI:1346226867
Name:VOGT, MISTY D (FNP)
Entity type:Individual
Prefix:MS
First Name:MISTY
Middle Name:D
Last Name:VOGT
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-7509
Mailing Address - Fax:314-237-6674
Practice Address - Street 1:450 N NEW BALLAS RD
Practice Address - Street 2:DEPT OTOLARYNGOLOGY, STE 140
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6859
Practice Address - Country:US
Practice Address - Phone:314-362-7509
Practice Address - Fax:314-237-6674
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424158301Medicaid