YOUR VILLAGE STL LLC NPI 1205552643

NPI Information

  • NPI: 1205552643
  • Provider Name: YOUR VILLAGE STL LLC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • Address: 1719 BIG HORN BASIN DR
    WILDWOOD, MO
    ZIP 63011
  • Phone: (314) 753-3982

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NPI Details

YOUR VILLAGE STL LLC is a pediatrics in Wildwood, MO. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. YOUR VILLAGE STL LLC NPI is 1205552643. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1719 BIG HORN BASIN DR
WILDWOOD, MO
ZIP 63011-821
Phone: (314) 753-3982

The provider's authorized official is Jennifer Tietjen .
The authorized official title is Owner and has the following contact phone number (314) 753-3982.

The enumeration date for this NPI number is 10/18/2022 and was last updated on 10/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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