STACEY E BROUK (NPI# 1558511048) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558511048 |
| Entity Type | Individual |
| Full Name | STACEY E BROUK |
| Credential | RD, LD |
| Practice Address |
10007 Kennerly Rd Suite A Saint Louis MO 63128-2179 |
| Mailing Address |
Po Box 29255 Saint Louis MO 63126-0255 |
| Practice Telephone | 3147767112 |
| Practice Fax Number | 3147767114 |
| Mailing Telephone | 3147767112 |
| Mailing Fax Number | 3147767114 |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2012-10-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133V00000X | Dietitian, Registered | 2008030030 | MO | Dietary & Nutritional Service Providers |
| Street Address |
10007 KENNERLY RD SUITE A |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63128-2179 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487745360 | David J Costigan | Internal Medicine | 10007 Kennerly Rd, Saint Louis, MO 63128-2179 | 2006-09-27 |
| 1427444074 | American Pain Clinic | Specialist | 10007 Kennerly Rd, Suite B, Saint Louis, MO 63128-2179 | 2015-04-10 |
| 1548418353 | Jason Michael Ameling | Chiropractor | 10007 Kennerly Rd, Saint Louis, MO 63128-2179 | 2008-09-04 |
| 1861651135 | Katherine Anne Hotaling | Dentist | 10007 Kennerly Rd, Saint Louis, MO 63128-2179 | 2008-06-03 |
| 1487811873 | Surgery Specialists of Missouri LLC | Specialist | 10007 Kennerly Rd, Suite A, Saint Louis, MO 63128-2179 | 2008-05-22 |
| 1346417250 | Kumaran Chinnappan | Surgery | 10007 Kennerly Rd, Suite A, Saint Louis, MO 63128-2179 | 2008-05-09 |
| 1811041387 | Ameling Chiropractic & Acupuncture, L.L.C. | Chiropractor | 10007 Kennerly Rd, Saint Louis, MO 63128-2179 | 2007-01-22 |
| 1194878108 | Lauren Alaine Ameling | Chiropractor | 10007 Kennerly Rd, Saint Louis, MO 63128-2179 | 2007-01-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771155 | James T Fetsch Dmd LLC | Dentist | 10004 Kennerly Rd Suite 240, Saint Louis, MO 63128 | 2019-10-11 |
| 1326504655 | Nikodem Dental Holdings | Dentist | 4337 Butler Hill Rd Suite G, St Louis Mo, MO 63128 | 2019-02-12 |
| 1932678505 | Michelle Anne Arvidson | Physical Therapy Assistant | Elite Physical Therapy, 12608 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2018-11-13 |
| 1245726710 | Kristen Rider | Nurse Practitioner | 9964 Kennerly Rd Ste D, Saint Louis, MO 63128 | 2018-07-07 |
| 1306217427 | Sophia Bednarski | Dentist | 12660 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2015-10-15 |
| 1427434224 | Darcie Burrus | Counselor | 12523 Old Tesson Rd G, St Louis, MO 63128 | 2015-08-04 |
| 1710368584 | Sara Hawatmeh | Internal Medicine | 12345 W Bend Dr Ste 304, Saint Louis, MO 63128 | 2015-06-17 |
| 1871989590 | Celia Grace Montes-kolence | Speech-Language Pathologist | 12335 W Bend Drive, Saint Louis, MO 63128 | 2015-04-09 |
| 1245629302 | Marius Antonio Evans | Dentist | 9911 Kennerly Rd., Suite G, St. Louis, MO 63128 | 2015-01-13 |
| 1801230313 | Sarah Elizabeth Walsh | Emergency Medicine | 10010 Kennerly Road, Emergency Department, St. Anthony's Medical Center, St. Louis, MO 63128 | 2013-04-26 |
| Find all providers in zip 63128 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760080550 | Abigail Wozniak | Dietitian, Registered | 4057 Flad Ave, Saint Louis, MO 63110-3924 | 2020-10-13 |
| 1033717962 | Jon Kuanfung | Dietitian, Registered | 1210 S Boyle Ave, Saint Louis, MO 63110-3814 | 2020-10-13 |
| 1063025153 | Macia Noorman | Dietitian, Registered | 2336 S Grand Blvd, Saint Louis, MO 63104-1755 | 2020-08-28 |
| 1447863865 | Serena E Mcphail | Dietitian, Registered | 3959a Potomac St, Saint Louis, MO 63116-3703 | 2020-08-25 |
| 1700496486 | Jennifer Ann Stripling | Dietitian, Registered | 12417 Dunedin Ln Apt 101, Saint Louis, MO 63146-2823 | 2020-08-06 |
| 1528677119 | Colleen E Madden | Dietitian, Registered | 5528 Pershing Ave Apt 205, Saint Louis, MO 63112-1769 | 2020-07-29 |
| 1043836315 | Abigail Debera Hallmark | Dietitian, Registered | 3510 Wyoming St Apt A, Saint Louis, MO 63118-2021 | 2020-06-22 |
| 1275163511 | Laura M Cusumano | Dietitian, Registered | 32 Oak Park Dr, Saint Louis, MO 63141-8428 | 2020-01-24 |
| 1689216871 | Healthy Bytes Solutions LLC | Dietitian, Registered | 20 S Sarah St, Saint Louis, MO 63108-2819 | 2019-10-09 |
| 1336797026 | Justa Davis | Dietitian, Registered | 3015 North Ballas, Saint Louis, MO 63131 | 2019-08-27 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63128 |
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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.