Healthcare Provider Details

I. General information

NPI: 1245247881
Provider Name (Legal Business Name): SHARON WOOTEN LPN, LNHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 1ST CAPITOL DR
SAINT CHARLES MO
63301-2734
US

IV. Provider business mailing address

2441 GOLFWAY ST
SAINT CHARLES MO
63301-1040
US

V. Phone/Fax

Practice location:
  • Phone: 636-724-7539
  • Fax: 636-724-7516
Mailing address:
  • Phone: 636-724-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number5401
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number047447
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: