Provider Demographics
NPI:1427246693
Name:THEVARY, VALSAMMA JAMES (NP)
Entity type:Individual
Prefix:MRS
First Name:VALSAMMA
Middle Name:JAMES
Last Name:THEVARY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:VALSAMMA
Other - Middle Name:
Other - Last Name:CHERIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6118 TERRI LYNN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-1678
Mailing Address - Country:US
Mailing Address - Phone:314-398-5170
Mailing Address - Fax:618-286-5646
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124739163W00000X
MO2013002091363LA2100X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care