Healthcare Provider Details

I. General information

NPI: 1750919478
Provider Name (Legal Business Name): LAUREN KATHERINE GAHIMER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2991 HIGHWAY K
O FALLON MO
63368-7862
US

IV. Provider business mailing address

2991 HIGHWAY K
O FALLON MO
63368-7862
US

V. Phone/Fax

Practice location:
  • Phone: 636-435-2333
  • Fax: 314-626-8009
Mailing address:
  • Phone: 636-435-2333
  • Fax: 314-626-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020024189
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2020010047
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28225665A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: