Provider Demographics
NPI:1164462172
Name:PRATT, VANESSA D (FNP)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:D
Last Name:PRATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2106
Mailing Address - Country:US
Mailing Address - Phone:618-470-6020
Mailing Address - Fax:618-470-6021
Practice Address - Street 1:1000 ELEVEN S STE 1A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1078
Practice Address - Country:US
Practice Address - Phone:618-470-6020
Practice Address - Fax:618-470-6021
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021640363LF0000X, 363L00000X
MO133125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425804838Medicaid