1487173654 NPI number — EDMOND JAMES MEYER BSN, RN, AE-C

Table of content: EDMOND JAMES MEYER BSN, RN, AE-C (NPI 1487173654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487173654 NPI number — EDMOND JAMES MEYER BSN, RN, AE-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
EDMOND
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN, AE-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487173654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2638 HIGHWAY 109 STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILDWOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63040-1161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-452-7689
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2638 HIGHWAY 109 STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILDWOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63040-1161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-452-7689
Provider Business Practice Location Address Fax Number:
636-452-7689
Provider Enumeration Date:
09/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X , with the licence number:  6086 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 151689 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 151689 . This is a "MISSOURI STATE BOARD OF NURSING" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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