Healthcare Provider Details

I. General information

NPI: 1760326425
Provider Name (Legal Business Name): SAMMER JUMAH ACKERMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 BIRCH VIEW CT
LAKE SAINT LOUIS MO
63367-6549
US

IV. Provider business mailing address

927 BIRCH VIEW CT
LAKE SAINT LOUIS MO
63367-6549
US

V. Phone/Fax

Practice location:
  • Phone: 636-279-4440
  • Fax:
Mailing address:
  • Phone: 636-279-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2026009625
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: