Individual provider Active NPI

Theresa A Boxdorfer, FNP

  • Family Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1063566768
Registry record updated Aug 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
126462 Issued in MO
Practice address
12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786
Phone
(314) 849-0311
Fax
(314) 849-4423
NPI assigned
Jan 22, 2007
Last updated
Aug 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 126462 MO Primary

Addresses

Primary practice location

12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786

Mailing address

12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786
Phone (314) 849-0311

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address terry.boxforfer@direct.signature.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070412000506 MO Practitioner - Nurse Practitioner 8729183199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Signature Medical Group IncGroup PAC ID 4880598291, 40 clinicians

Practice addresses (Care Compare)

12639 Old Tesson Rd
Suite 115
Saint Louis, MO 63128-2786
Phone 31484903112384

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Medical Group, Inc CurrentSince Dec 12, 2006 Accepting new patients
Signature Medical Group, Inc CurrentSince Dec 12, 2006 Accepting new patients

Locations

1011 Bowles Ave
Ste 100
Fenton, MO 63026

12639 Old Tesson Rd
Ste 115
Saint Louis, MO 63128
Phone (314) 842-8655

Interoperability endpoints

  • Direct secure messaging: terry.boxforfer@direct.signature.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755561600000",
    "number": "1063566768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12639 OLD TESSON RD",
            "address_2": "SUITE 115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282786",
            "telephone_number": "314-849-0311",
            "fax_number": "314-849-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12639 OLD TESSON RD",
            "address_2": "SUITE 115",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282786",
            "telephone_number": "314-849-0311",
            "fax_number": "314-849-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOXDORFER",
        "first_name": "THERESA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "126462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "terry.boxforfer@direct.signature.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "12639 Old Tesson Rd",
            "address_2": "Suite 115",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631282786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.