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

Stacy M Wiley, NURSEPRACTITIONER

Individual provider Gerontology Nurse Practitioner · NPI 1669176046

Stacy M Wiley, NURSEPRACTITIONER is a Nurse Practitioner in Bridgeton, Missouri. Qualified in 2021, 5 years ago. Practices with SSM Medical Group Inc, a 560-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Missouri.

Years since qualifying
5
Licensed in
MO
In the registry since
2023
Specialties on file
2

Practice location Address checks out

12277 De Paul Dr Ste 403
Bridgeton, MO 63044-2536
Phone: (314) 738-2715
Show map & directions

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

Additional practice locations (1)

  • 3933 S Broadway, Saint Louis, MO 63118-4696 — (314) 865-7924

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 2022044057 (MO)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence 2022044057 (MO)

Record details

NPI number1669176046
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedMarch 29, 2023
Last updated in NPPESOctober 27, 2023
Certification dateOctober 27, 2023
Mailing addressPo Box 955534, Saint Louis, MO 63195-5534

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Ssm Medical Group Inc — 560 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Bridgeton