Healthcare Provider Details

I. General information

NPI: 1043770589
Provider Name (Legal Business Name): TAYLOR MARIE SACHTLEBEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR MARIE BOGUE PA-C

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 387C
SAINT LOUIS MO
63131-2324
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7220
  • Fax: 314-996-7225
Mailing address:
  • Phone: 314-996-7220
  • Fax: 314-996-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006994
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2023038567
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: