Individual provider Active NPI

Andrea Wilkinson, RN BSN

  • General Practice Registered Nurse
  • Saint Louis, MO
National Provider Identifier
1114785821
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
2017006262 Issued in MO
Practice address
3615 Olive St
Saint Louis, MO 63108-3604
Phone
(314) 289-6540
Fax
(314) 289-6301
NPI assigned
Mar 7, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 2017006262 MO Primary

Addresses

Primary practice location

3615 Olive St
Saint Louis, MO 63108-3604

Mailing address

250 Martigney Dr
Saint Louis, MO 63129-3412
Phone (314) 315-2942

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
2017006262MOMDGeneral Practice Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1114785821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 MARTIGNEY DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631293412",
            "telephone_number": "314-315-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 OLIVE ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083604",
            "telephone_number": "314-289-6540",
            "fax_number": "314-289-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKINSON",
        "first_name": "ANDREA",
        "credential": "RN BSN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "MO",
            "license": "2017006262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; 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.