Healthcare Provider Details

I. General information

NPI: 1750257093
Provider Name (Legal Business Name): NAC HAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N OUTER 40 RD STE 200
CHESTERFIELD MO
63017-2152
US

IV. Provider business mailing address

14825 N OUTER 40 RD STE 200
CHESTERFIELD MO
63017-2152
US

V. Phone/Fax

Practice location:
  • Phone: 314-336-2555
  • Fax:
Mailing address:
  • Phone: 314-336-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ASHLEY GARDNER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 314-377-5289