Healthcare Provider Details

I. General information

NPI: 1568322923
Provider Name (Legal Business Name): NATALIE ANN DAMERON MMS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE ANN MILLER

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 W LIBERTY ST
FARMINGTON MO
63640-1921
US

IV. Provider business mailing address

PO BOX 957683
SAINT LOUIS MO
63195-7683
US

V. Phone/Fax

Practice location:
  • Phone: 573-760-8090
  • Fax: 573-760-8260
Mailing address:
  • Phone: 573-760-8090
  • Fax: 573-760-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026006462
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: