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

Rebecca Deatherage Buwalda, APRNBC

Individual provider Nurse Practitioner · NPI 1366477226

Rebecca Deatherage Buwalda, APRNBC is a Nurse Practitioner in Bridgeton, Missouri. Qualified in 1999, 27 years ago. Practices with SSM Medical Group Inc, a 560-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
27
Licensed in
MO
In the registry since
2006

Practice location Address checks out

12255 De Paul Dr Ste 600
Bridgeton, MO 63044-2515
Phone: (314) 209-5100
Fax: (314) 291-9508
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence FNP 124462 (MO)

Record details

NPI number1366477226
Entity typeIndividual (Type 1)
GenderFemale
Credentials APRNBC
Sole proprietorNo
NPI enumeratedJuly 11, 2006
Last updated in NPPESOctober 20, 2020
Certification dateOctober 20, 2020

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 1999 (27 years in practice)
Group practice Ssm Medical Group Inc — 560 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Bridgeton