Provider Demographics
NPI:1689673956
Name:BIRTLEY, NANCY (PMHNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BIRTLEY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 MID RIVERS MALL DR
Mailing Address - Street 2:SUITE 317
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1102
Mailing Address - Country:US
Mailing Address - Phone:636-244-4500
Mailing Address - Fax:636-244-4505
Practice Address - Street 1:6209 MID RIVERS MALL DR
Practice Address - Street 2:SUITE 317
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63304-1102
Practice Address - Country:US
Practice Address - Phone:636-244-4500
Practice Address - Fax:636-244-4505
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107603364SP0809X
MO2015034704363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424724110Medicaid
MOP00171562OtherRAILROAD MEDICARE