REBECCA DEATHERAGE BUWALDA (NPI# 1366477226) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366477226 |
| Entity Type | Individual |
| Full Name | REBECCA DEATHERAGE BUWALDA |
| Credential | APRNBC |
| Practice Address |
12255 De Paul Dr Ste 600 Bridgeton MO 63044-2515 |
| Mailing Address |
Po Box 955534 Saint Louis MO 63195-2510 |
| Practice Telephone | 3142095100 |
| Practice Fax Number | 3142919508 |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-10-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | FNP 124462 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | RAILROAD MEDICARE | P21556 | 01 |
| Street Address |
12255 DE PAUL DR STE 600 |
| City | BRIDGETON |
| State | MO |
| Zip Code | 63044-2515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457842213 | Tyla Aliece Johnson | Nurse Practitioner | 12255 De Paul Dr Ste 600, Bridgeton, MO 63044-2515 | 2018-05-28 |
| 1184157158 | Molly E Peverada | Family Medicine | 12255 De Paul Dr Ste 600, Bridgeton, MO 63044-2515 | 2017-04-06 |
| 1528106739 | Raad R Roubey | Internal Medicine | 12255 De Paul Dr Ste 600, Bridgeton, MO 63044-2515 | 2007-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073150017 | Zoe Marie Wadsworth | Nurse Practitioner | 12255 Depaul Dr Suite 300, Bridgeton, MO 63044 | 2019-12-10 |
| 1609412451 | Beyond Better, Best Home Health Care Services, Limited Liability Corpo | In Home Supportive Care | 3430 Mckelvey Road Ste B, Bridgeton, MO 63044 | 2019-11-26 |
| 1275189078 | Delicate Angels Home Health LLC | Home Health | 11726 St. Charles Rock Road Suite G, Bridgeton, MO 63044 | 2019-08-16 |
| 1588210082 | Nicholas Huber | Physical Therapist | 12349 Depaul Dr., Ste. 110, Bridgeton, MO 63044 | 2019-08-12 |
| 1124688858 | Michelle Bassett | Registered Nurse | 11520 St. Charles Rock Rd., Suite 106, Bridgeton, MO 63044 | 2019-06-14 |
| 1336703883 | Elena A Barrow | Nurse Practitioner | 12255 Depaul Dr, Suite 260, Bridgeton, MO 63044 | 2019-04-30 |
| 1487123105 | Laura N Steiner | Registered Nurse | Gateway Pediatrics, Ltd, 12255 Depaul Drive, Suite 460 North Medical Building, Bridgeton, MO 63044 | 2018-11-26 |
| 1205310950 | Danielle Mathis | Nurse Practitioner | 3440 Depaul Lane Suite 201, Bridgeton, MO 63044 | 2018-09-19 |
| 1588163570 | Thoughts Out Loud Counseling, LLC | Social Worker | 11520 St. Charles Rock Road Suite 101, Bridgeton, MO 63044 | 2018-02-06 |
| 1912411430 | Breanna Victoria Hayes | Counselor | 3165 Mckevley Road, Suite 200, Bridgeton, MO 63044 | 2017-11-20 |
| Find all providers in zip 63044 | ||||
| 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 |
|---|---|---|---|---|
| 1447619465 | Jamison Ebert | Nurse Practitioner | 12255 De Paul Dr Ste 205, Bridgeton, MO 63044-2510 | 2016-02-18 |
| 1942548813 | Famcare, Inc | Nurse Practitioner | 570 Chestnut Ave, Bridgeton, NJ 08302-1319 | 2013-01-27 |
| 1871762385 | Doctor's Clinical Group | Nurse Practitioner | 12255 Depaul Drive Suite 865, Bridgeton, MO 63044 | 2008-02-28 |
| 1982160990 | Nickolas Rongey | Nurse Practitioner | 3550 Mckelvey Rd, Bridgeton, MO 63044-2527 | 2019-02-14 |
| 1659865129 | Christine Ella Lindsay | Nurse Practitioner | 12345 Saint Charles Rock Rd, Bridgeton, MO 63044-2505 | 2018-06-19 |
| 1932628807 | Nutressa Monroe | Nurse Practitioner | 12800 Boenker Ln, Bridgeton, MO 63044-2438 | 2017-09-12 |
| 1295253581 | Amanda Michelle Huxtable | Nurse Practitioner | 12303 De Paul Dr, Bridgeton, MO 63044-2512 | 2017-09-06 |
| 1750809224 | Mark Joseph Knotts | Nurse Practitioner | 12303 De Paul Dr, Bridgeton, MO 63044-2512 | 2017-09-06 |
| 1760933956 | Jeanalyn Guthrie | Nurse Practitioner | 12774 Boenker Ln, Bridgeton, MO 63044-2436 | 2016-10-22 |
| 1760846414 | Rachel Heft | Nurse Practitioner | 12255 De Paul Dr, Suite 200, Bridgeton, MO 63044-2510 | 2016-04-08 |
| Find all providers in BRIDGETON | ||||
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| 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.