Individual provider Active NPI

Brittany Shoults, AGPCNP

  • Primary Care Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1649721192
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
T092216004 Issued in MO
Practice address
10012 Kennerly Rd Ste 300
Saint Louis, MO 63128-2197
Phone
(314) 842-0602
NPI assigned
Oct 19, 2016
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X T092216004 MO Primary

Addresses

Primary practice location

10012 Kennerly Rd Ste 300
Saint Louis, MO 63128-2197

Mailing address

10012 Kennerly Rd Ste 300
Saint Louis, MO 63128-2197
Phone (314) 842-0602

Other practice location 1

10012 Kennerly Rd
Saint Louis, MO 63128-2197
Phone (314) 842-0602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20161114000917 MO Practitioner - Nurse Practitioner 0648559765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Heart and Vascular LLCGroup PAC ID 8820016207, 112 clinicians

Practice addresses (Care Compare)

10012 Kennerly Rd
Suite 300
Saint Louis, MO 63128-2197
Phone (314) 842-0602

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
T092216004MOMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Heart and Vascular, LLC CurrentSince Jan 1, 2020 Accepting new patients
Saint Luke's Physician Group Inc Past Accepting new patients

Locations

1001 S Kirkwood Rd
Ste 310
Saint Louis, MO 63122
Phone (314) 692-2807

10012 Kennerly Rd
Ste 202
Saint Louis, MO 63128
Phone (314) 692-2807

10012 Kennerly Rd
Ste 300
Saint Louis, MO 63128
Phone (314) 842-0602

4280 Mid America Ln
Ste 10
Saint Louis, MO 63129
Phone (314) 692-2807

625 S New Ballas Rd
Ste 2015
Saint Louis, MO 63141
Phone (314) 251-1775

7345 Watson Rd
#1
Saint Louis, MO 63119
Phone (314) 692-2807

Organizations & group practices 2

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1649721192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10012 KENNERLY RD STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282197",
            "telephone_number": "314-842-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10012 KENNERLY RD STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282197",
            "telephone_number": "314-842-0602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10012 Kennerly Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631282197",
            "country_code": "US",
            "telephone_number": "314-842-0602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOULTS",
        "first_name": "BRITTANY",
        "credential": "AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-19",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MO",
            "license": "T092216004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.