Individual provider Active NPI

La Tanya Lawrence, AS

  • Family Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1104121102
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2019005430 Issued in MO
Practice address
175 N Oaks PLZ
Saint Louis, MO 63121-2925
Phone
(314) 391-9777
Fax
(314) 390-5404
NPI assigned
Jan 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 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 2019005430 MO Primary

Addresses

Primary practice location

175 N Oaks PLZ
Saint Louis, MO 63121-2925

Mailing address

175 N Oaks PLZ
Saint Louis, MO 63121-2925
Phone (314) 391-9777

Other identifiers 1

IdentifierTypeStateIssuer
G9011663OtherMOUNITED HEALTH PLUS INSURANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190816002633 MO Practitioner - Nurse Practitioner 2163743071 Reassigns benefits to 3 organizations
I20260225001823 IL Practitioner - Nurse Practitioner 2163743071 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4055 Valley View LN
Suite 700
Dallas, TX 75244-4910

4055 Valley View LN
Suite 700
Dallas, TX 75244-5045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Town Medical Practice, LLC CurrentSince Aug 2, 2019 Accepting new patients
Assiduous Home Care LLC Current Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Jan 17, 2026 Accepting new patients
Signify Health, LLC CurrentSince Jan 14, 2026 Accepting new patients

Locations

102 N Main St
#3
Columbia, IL 62236

2300 Main St
Fl 9
Kansas City, MO 64108
Phone (800) 416-1767

4433 Woodson Rd
Ste 220
Saint Louis, MO 63134
Phone (314) 265-7131

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

4055 Valley View Ln
Ste 700
Dallas, TX 75244
Phone (469) 466-7424

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1104121102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 N OAKS PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631212925",
            "telephone_number": "314-391-9777",
            "fax_number": "314-390-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N OAKS PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631212925",
            "telephone_number": "314-391-9777",
            "fax_number": "314-390-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "LA TANYA",
        "credential": "AS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-21",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2019005430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH PLUS INSURANCE",
            "identifier": "G9011663",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.