Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Matthew Dale Tieskoetter, APRN

Individual provider Adult Health Nurse Practitioner · NPI 1508482506

Matthew Dale Tieskoetter, APRN is a Nurse Practitioner in Bridgeton, Missouri. Qualified in 2018, 8 years ago. Practices with SSM Medical Group Inc, a 560-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
8
Licensed in
MO
In the registry since
2020
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.

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Practice location Address checks out

12349 De Paul Dr Ste 100
Bridgeton, MO 63044-2512
Phone: (314) 291-7900
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 333 S Kirkwood Rd Ste 203, Saint Louis, MO 63122-6161 — (314) 909-1666

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 2020003584 (MO)

Record details

NPI number1508482506
Entity typeIndividual (Type 1)
GenderMale
Credentials APRN
Sole proprietorNo
NPI enumeratedJune 25, 2020
Last updated in NPPESOctober 17, 2022
Certification dateOctober 17, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Ssm Medical Group Inc — 560 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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