Individual provider Active NPI

Davina Angelene Dupree, NP

  • Adult Health Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1982071262
Registry record updated Aug 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2010021378 Issued in MO
Practice address
12101 Woodcrest Executive Dr
Suite 210
Saint Louis, MO 63141-5047
Phone
(314) 317-0600
Fax
(314) 317-0606
NPI assigned
Aug 21, 2015
Last updated
Aug 21, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2010021378 MO Primary
Gerontology Nurse Practitioner 363LG0600X 2010021378 MO

Addresses

Primary practice location

12101 Woodcrest Executive Dr
Suite 210
Saint Louis, MO 63141-5047

Mailing address

12101 Woodcrest Executive Dr
Suite 210
Saint Louis, MO 63141-5047
Phone (314) 317-0600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20241213002638 AZ Practitioner - Nurse Practitioner 9436465572 Reassigns benefits to 1 organization
I20260208000152 DC Practitioner - Nurse Practitioner 9436465572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2010021378MOMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medpsyche Health & Wellness Current Accepting new patients
Grow Healthcare Group PA CurrentSince Nov 13, 2024 Accepting new patients

Locations

4600 E Washington St
Ste 300
Phoenix, AZ 85034
Phone (602) 638-1872

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598

Interoperability endpoints

  • Direct secure messaging: ddupree@landmarkhealth-direct.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440115200000",
    "number": "1982071262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR",
            "address_2": "SUITE 210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR",
            "address_2": "SUITE 210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUPREE",
        "first_name": "DAVINA",
        "middle_name": "ANGELENE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2010021378",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2010021378",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.