SAMANTHA NICOLE LILLICO (NPI# 1093225815) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093225815 |
| Entity Type | Individual |
| Full Name | SAMANTHA NICOLE LILLICO |
| Credential | FNP-C |
| Practice Address |
9556 Manchester Rd Saint Louis MO 63119 |
| Mailing Address |
628 Woodstream Dr Saint Charles MO 63304-7971 |
| Practice Telephone | 3149612255 |
| Mailing Telephone | 6362558090 |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2018-05-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 71007531A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 2017024415 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 812 Prince Andrew Ct, Saint Charles, MO 633045015 | 6362558090 |
| Street Address |
9556 MANCHESTER RD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598747727 | Troy Adam Dinkel | Emergency Medicine | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2005-11-15 |
| 1104430776 | Shannon Elyse Stewart | Physician Assistant | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2020-09-01 |
| 1003425414 | Taylor Nicole Melgar | Physician Assistant | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2020-07-31 |
| 1144848805 | Steven Nathan Silvestain | Physician Assistant | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2020-07-09 |
| 1699300087 | Carley Johnah Dykstra | Physician Assistant | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2020-03-06 |
| 1982262812 | Jennifer M Coxwell | Nurse Practitioner | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2019-06-05 |
| 1932667193 | Laura Elizabeth Riesberg | Physician Assistant | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2019-03-06 |
| 1083171128 | Taylor Kristen Delmain | Physician Assistant | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2019-02-25 |
| 1972069664 | Kristine D Schneider | Physician Assistant | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2019-02-18 |
| 1619441920 | Jevon Michael Huang | Physician Assistant | 9556 Manchester Rd, Saint Louis, MO 63119-1313 | 2019-01-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114525631 | Kaylen A Howard | Specialist/Technologist | No, No, MO 63119 | 2020-10-16 |
| 1053887612 | St. Gianna Pediatrics, LLC | Pediatrics | 7387 Watson Road, Shrewsbury, MO 63119 | 2018-10-22 |
| 1982140265 | Forefront Dermatology, S.c. | Dermatology | 8567 Watson Rd, Webster Groves, MO 63119 | 2017-01-11 |
| 1407308018 | Tyler Clark | Student in an Organized Health Care Education/Training Program | 7785 Keswick Pl, Saint Louis, MO 63119 | 2016-10-30 |
| 1396109880 | Ritesh Gandhi | Family Medicine | 7345 Watson Rd Ste 203, Saint Louis, MO 63119 | 2016-04-11 |
| 1568834489 | Antonio Robinson | Counselor | 330 N. Gore, Great Circle, Saint Louis, MO 63119 | 2015-10-30 |
| 1922484039 | Odessa Baker X | Dietary Manager | 525 N. Laclede Station Road, St. Louis, MO 63119 | 2015-07-31 |
| 1194114694 | Laura Maher | Social Worker | 201 W. Lockwood Ave, Suite 201, St. Louis, MO 63119 | 2015-01-21 |
| 1427314046 | Dick (richard) Ralph Brummett | Family Medicine | 711 S Laclede Sta Rd, # 2111, St Louis, MO 63119 | 2012-04-09 |
| 1972872935 | Dolliene A. Raabe | Social Worker | 8050 Watson Road, Suite 201, St. Louis, MO 63119 | 2011-12-21 |
| Find all providers in zip 63119 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184221160 | Zachary Wade Orr | Nurse Practitioner | 1622 S 18th St, Saint Louis, MO 63104-2504 | 2020-10-02 |
| 1073128518 | Christen Rincker | Nurse Practitioner | 2343 Hickory St, Saint Louis, MO 63104-2418 | 2020-09-11 |
| 1861026650 | Kelly Ann Clark | Nurse Practitioner | 4590 Childrens Pl, Saint Louis, MO 63110-1020 | 2020-03-02 |
| 1902444292 | Tony Duy Le | Nurse Practitioner | 1251 Hyannis Dr, Saint Louis, MO 63146-4639 | 2019-12-17 |
| 1114562154 | Lisa Pezold | Nurse Practitioner | 2029 Woodland Pkwy, Saint Louis, MO 63146-4267 | 2019-11-13 |
| 1255806527 | Rachel Ramos | Nurse Practitioner | 11133 Dunn Rd Ste 209e, Saint Louis, MO 63136-6163 | 2018-10-12 |
| 1851893341 | Jessica Rae Britt | Nurse Practitioner | 1 Barnes Jewish Hospital Plz Fl 10, 10th Fl, Saint Louis, MO 63110-1003 | 2018-03-01 |
| 1952816449 | Loreta Shahinaj | Nurse Practitioner | 12700 Southfork Rd Ste 270, Saint Louis, MO 63128-3201 | 2017-12-06 |
| 1689183832 | Natalie Michelle Barone | Nurse Practitioner | 3023 N Ballas Rd Ste 630, Saint Louis, MO 63131-2361 | 2017-09-20 |
| 1194240986 | Laura Kaesser | Nurse Practitioner | 11125 Dunn Rd Ste 204, Saint Louis, MO 63136-6188 | 2017-08-14 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63119 |
Please comment or provide details below to improve the information on SAMANTHA NICOLE LILLICO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.