Tanika Joi Prowell, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

2006007421 Issued in MO

Practice address

4000 Jennings Station Rd
Saint Louis, MO 63121-3323

Phone

(314) 679-7880

Fax

(314) 679-7846

NPI assigned

Oct 13, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318464000000",
    "number": "1104101872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S MERAMEC AVE",
            "address_2": "41 S CENTRAL AVE",
            "city": "CLAYTON",
            "state": "MO",
            "postal_code": "631051711",
            "telephone_number": "314-615-0600",
            "fax_number": "314-615-8303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 JENNINGS STATION RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631213323",
            "telephone_number": "314-679-7880",
            "fax_number": "314-679-7846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROWELL",
        "first_name": "TANIKA",
        "middle_name": "JOI",
        "name_prefix": "Miss",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-13",
        "last_updated": "2011-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2006007421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.