Healthcare Provider Details

I. General information

NPI: 1619801180
Provider Name (Legal Business Name): SARA COUSSENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15740 S OUTER 40 RD
CHESTERFIELD MO
63017-2004
US

IV. Provider business mailing address

1402 N SMILEY ST
O FALLON IL
62269-6755
US

V. Phone/Fax

Practice location:
  • Phone: 636-735-4930
  • Fax: 636-735-4930
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041453006
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number2010026815
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: