MATTHEW DALE TIESKOETTER (NPI# 1508482506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508482506 |
| Entity Type | Individual |
| Full Name | MATTHEW DALE TIESKOETTER |
| Credential | APRN |
| Practice Address |
333 S Kirkwood Rd Ste 203 Saint Louis MO 63122-6161 |
| Mailing Address |
716 Clarence Dr Saint Charles MO 63301-0150 |
| Practice Telephone | 3149091666 |
| Mailing Telephone | 3142036104 |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
2020003584 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
333 S KIRKWOOD RD STE 203 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63122-6161 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659933174 | Keela Rushing | Physical Therapist | 439 S Kirkwood Rd Ste 200, Kirkwood, MO 63122 | 2019-07-04 |
| 1730643461 | Kirkwood Family Dental | Dentist | 333 S Kirkwood Road, Suite 105, Kirkwood, MO 63122 | 2019-01-28 |
| 1477061166 | Total Access Urgent Care, PC | Clinic/Center | 2980 Dougherty Ferry Rd, Saint Louis, MO 63122 | 2018-01-16 |
| 1760933469 | Missouri Cvs Pharmacy, L.l.c | Durable Medical Equipment & Medical Supplies | 10820 Manchester Rd, Kirkwood, MO 63122 | 2016-10-18 |
| 1518321041 | M. Kathleen Blanchard | Counselor | 11042 Manchester Rd., Kirkwood, MO 63122 | 2016-04-11 |
| 1265801914 | Kim Grega | Counselor | 700 S Kirkwood Rd, Kirkwood, MO 63122 | 2015-09-23 |
| 1245617943 | Mark Edward Taylor | Dentist | 610 North Geyer, Kirkwood, MO 63122 | 2015-05-01 |
| 1467843094 | Mary Elizabeth Boomgarden | Physical Therapist | 9645 Big Bend Boulevard, Saint Louis, MO 63122 | 2015-02-18 |
| 1760725717 | Michael Diller Counseling | Counselor | 144 W Madison Avenue, Kirkwood, MO 63122 | 2013-03-28 |
| 1427309954 | Anne Marie Delaplain | Dentist | 725 Laclede Station Road, Webster Groves, MO 63122 | 2012-09-24 |
| Find all providers in zip 63122 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023619285 | Jennifer Lee Speiser | Nurse Practitioner | 12545 Olive Blvd, Saint Louis, MO 63141-6311 | 2020-11-04 |
| 1265045264 | Andrea Jane Montgomery | Nurse Practitioner | 444 Honeysuckle Ln, Saint Louis, MO 63119-4521 | 2020-08-28 |
| 1396362224 | Erin M Kehoe | Nurse Practitioner | 12973 Olive Blvd, Saint Louis, MO 63141-6149 | 2020-06-26 |
| 1861033615 | Benedicta Esi | Nurse Practitioner | 6024 Pennsylvania Ave, Saint Louis, MO 63111-2555 | 2019-10-02 |
| 1245896893 | Katina D Smith | Nurse Practitioner | 8820 Mcnulty Dr, Saint Louis, MO 63114-4146 | 2019-05-18 |
| 1912413584 | Lucija Kozul Sadl | Nurse Practitioner | 3525 Forest Dale Dr, Saint Louis, MO 63125-4212 | 2017-12-19 |
| 1275071326 | Kathryn Ries | Nurse Practitioner | 3535 South Broadway, Suite 118, Saint Louis, MO 63118-3907 | 2017-02-09 |
| 1144775966 | Hienok Hailu | Nurse Practitioner | 11725 Casa Grande Dr, Saint Louis, MO 63146-4223 | 2016-08-22 |
| 1992167522 | Lanyn Clark | Nurse Practitioner | 40 Ladue Ter, Saint Louis, MO 63124-2048 | 2016-03-23 |
| 1639565823 | Laura C. Fleetwood | Nurse Practitioner | 625 S New Ballas Rd Ste R-7040, Saint Louis, MO 63141-8253 | 2015-04-14 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63122 |
Please comment or provide details below to improve the information on MATTHEW DALE TIESKOETTER.
| 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.