Healthcare Provider Details

I. General information

NPI: 1861337107
Provider Name (Legal Business Name): LAURA SPROUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HUTCHINSON RD
BALLWIN MO
63011-5702
US

IV. Provider business mailing address

3334 IPSWICH LN
SAINT CHARLES MO
63301-1069
US

V. Phone/Fax

Practice location:
  • Phone: 636-591-1086
  • Fax:
Mailing address:
  • Phone: 314-917-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number2019004597
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: