Provider Demographics
NPI:1053359281
Name:TUTTLE, ALLISON GRACE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:GRACE
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:GRACE
Other - Last Name:LYNDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:621 S. NEW BALLAS RD.
Mailing Address - Street 2:MIDWEST SPINE SURGEONS
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-251-3990
Mailing Address - Fax:
Practice Address - Street 1:615 S. NEW BALLAS RD
Practice Address - Street 2:MERCY HOSPITAL ST. LOUIS
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-251-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006981363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000097324Medicare ID - Type Unspecified
Q69808Medicare UPIN