Healthcare Provider Details

I. General information

NPI: 1255028122
Provider Name (Legal Business Name): ERIN FRIESEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9323 PHOENIX VILLAGE PKWY
O FALLON MO
63368-4281
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-0400
  • Fax:
Mailing address:
  • Phone: 636-695-0400
  • Fax: 636-916-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2024037659
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: