Healthcare Provider Details

I. General information

NPI: 1376418657
Provider Name (Legal Business Name): NICOLE OGDEN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10019 SETTLE MILL RD
CADET MO
63630
US

IV. Provider business mailing address

10019 SETTLE MILL RD
CADET MO
63630
US

V. Phone/Fax

Practice location:
  • Phone: 573-436-6706
  • Fax: 573-436-5772
Mailing address:
  • Phone: 573-436-6706
  • Fax: 573-436-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number2019009609
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: