Justin Lynn Northcutt, PA-C
Physician Assistant in St. Louis, MO. Individual provider (NPI-1).
NPI number1194351668
StatusActive
Last updated in NPPESNov 2, 2026
Details
- NPI
- 1194351668
- Entity type
- Individual (NPI-1)
- Name
- Mr. Justin Lynn Northcutt
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 17, 2020
- Certification date
- Mar 17, 2020
- Last updated
- Nov 2, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 085007547 | IL | Yes |
Practice location
12639 Old Tesson Rd.Suite 115
St. Louis, MO 63128-2786
Phone 314-849-0311 · Fax 314-849-4423
Mailing address
12639 Old Tesson Rd.Suite 115
St. Louis, MO 63128-2786
Phone 314-849-0311 · Fax 314-849-4423
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