Patty Declue, RN CCM

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

108863 Issued in MO

Practice address

506 Sumac Field CT
Ellisville, MO 63021-5974

Phone

(314) 920-9207

NPI assigned

Jan 20, 2022

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

Electronic endpoints 1

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": "1642636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1326790452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1391 NW 136TH AVE",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 SUMAC FIELD CT",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630215974",
            "telephone_number": "314-920-9207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECLUE",
        "first_name": "PATTY",
        "credential": "RN CCM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "MO",
            "license": "108863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Ellisville",
            "affiliation": "N",
            "address_1": "506 Sumac Field Ct",
            "city": "Ellisville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630215974",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Case Management Registered Nurse in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Case Management Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.