Healthcare Provider Details

I. General information

NPI: 1225499866
Provider Name (Legal Business Name): RACHEL DORMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL HARRIS NP

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 STATE HIGHWAY K STE 100
O'FALLON MO
63368
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-5454
  • Fax:
Mailing address:
  • Phone: 636-240-5454
  • Fax: 636-980-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015041114
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015041114
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: