Provider Demographics
NPI:1871604561
Name:HEDGES, ROBYN
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:HEDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:573-732-5140
Mailing Address - Fax:573-732-5689
Practice Address - Street 1:240 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOURBON
Practice Address - State:MO
Practice Address - Zip Code:65441-8308
Practice Address - Country:US
Practice Address - Phone:573-732-5140
Practice Address - Fax:573-732-5689
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425885704Medicaid
MO425885704Medicaid
MO000081393Medicare PIN