Healthcare Provider Details

I. General information

NPI: 1942142468
Provider Name (Legal Business Name): SIERRA ACKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12124 SAINT CLEMENT
SAINT LOUIS MO
63131-4021
US

IV. Provider business mailing address

12124 SAINT CLEMENT
SAINT LOUIS MO
63131-4021
US

V. Phone/Fax

Practice location:
  • Phone: 314-596-6839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: