Provider Demographics
NPI:1528299039
Name:MULLOY, ROBERT J (ANP,)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:MULLOY
Suffix:
Gender:M
Credentials:ANP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11063 SAINT FRANCIS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-3333
Mailing Address - Country:US
Mailing Address - Phone:314-680-3761
Mailing Address - Fax:
Practice Address - Street 1:11063 SAINT FRANCIS LN
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-3333
Practice Address - Country:US
Practice Address - Phone:314-680-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018905363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health