Active NPI
Desiree Reinken
- Family Nurse Practitioner
- Villa Ridge, MO
National Provider Identifier
1184219339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F10200667
- Practice address
- 956 Rosetta Dr
Villa Ridge, MO 63089-1297 - Phone
- (636) 402-8517
- NPI assigned
- Mar 9, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F10200667 | MO | Primary |
Addresses
Primary practice location
956 Rosetta Dr
Villa Ridge, MO 63089-1297
Mailing address
109 Highway at
Villa Ridge, MO 63089-2107
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F10200667 | MO | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617753600000",
"number": "1184219339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 HIGHWAY AT",
"city": "VILLA RIDGE",
"state": "MO",
"postal_code": "630892107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "956 ROSETTA DR",
"city": "VILLA RIDGE",
"state": "MO",
"postal_code": "630891297",
"telephone_number": "636-402-8517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REINKEN",
"first_name": "DESIREE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-09",
"last_updated": "2021-04-07",
"certification_date": "2021-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "F10200667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Villa Ridge, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.