Individual provider Active NPI

Mia Glover, FNP-C

  • Family Nurse Practitioner
  • Arnold, MO
National Provider Identifier
1821456112
Registry record updated Aug 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2015044717 Issued in MO
Practice address
3619 Richardson Square Dr
Arnold, MO 63010-6022
Phone
(636) 717-6700
NPI assigned
Feb 2, 2016
Last updated
Aug 18, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2015044717 MO Primary

Addresses

Primary practice location

3619 Richardson Square Dr
Arnold, MO 63010-6022

Mailing address

PO Box 776084
Chicago, IL 60677-6084
Phone (314) 364-4200

Other practice location 1

2991 Highway K # 6
O Fallon, MO 63368-7862
Phone (636) 435-2333

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
I20160811001072 MO Practitioner - Nurse Practitioner 2466746680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy East Ambulatory Services LLCGroup PAC ID 2365739240, 102 clinicians

Practice addresses (Care Compare)

2991 Hwy K
O Fallon, MO 63368-7862
Phone (636) 435-2333

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy East Ambulatory Services LLC CurrentSince Aug 17, 2022 Accepting new patients

Locations

714 Gravois Rd
Ste 100
Fenton, MO 63026
Phone (636) 326-6100

409 Lafayette Ctr
Manchester, MO 63011
Phone (636) 707-0764

2991 Highway K
O Fallon, MO 63368
Phone (636) 435-2333

2991 Highway K
#6
O Fallon, MO 63368
Phone (636) 435-2333

901 Patients First Dr
Ste 1200
Washington, MO 63090
Phone (636) 390-1777

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1821456112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776084",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776084",
            "telephone_number": "314-364-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3619 RICHARDSON SQUARE DR",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "630106022",
            "telephone_number": "636-717-6700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2991 Highway K # 6",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "MO",
            "postal_code": "633687862",
            "country_code": "US",
            "telephone_number": "636-435-2333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLOVER",
        "first_name": "MIA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-02",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2015044717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arnold, MO

Sources for this page

Verify at the official NPI Registry.