NPIMap

Organization Active NPI

Your Village STL LLC

  • Pediatrics Physician
  • Wildwood, MO
National Provider Identifier
1205552643
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
YOUR VILLAGE STL LLC
Practice address
1719 Big Horn Basin Dr
Wildwood, MO 63011-4821
Phone
(314) 753-3982
NPI assigned
Oct 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Authorized official

Name
Jennifer Tietjen, CPNPNPI 1831432814
Title
Owner
Phone
(314) 753-3982

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1719 Big Horn Basin Dr
Wildwood, MO 63011-4821

Mailing address

1719 Big Horn Basin Dr
Wildwood, MO 63011-4821
Phone (314) 753-3982

National Provider Directory

National Provider Directory

Locations

78 Clarkson Wilson Ctr
Chesterfield, MO 63017
Phone (314) 485-7243

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1205552643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 BIG HORN BASIN DR",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630114821",
            "telephone_number": "314-753-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 BIG HORN BASIN DR",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "630114821",
            "telephone_number": "314-753-3982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR VILLAGE STL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-18",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "TIETJEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-753-3982",
        "authorized_official_credential": "CPNP"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildwood, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.