Healthcare Provider Details

I. General information

NPI: 1194651364
Provider Name (Legal Business Name): SARA KOEPKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 GREEN GARDEN DR
SAINT ANN MO
63074-3303
US

IV. Provider business mailing address

13 GREEN GARDEN DR
SAINT ANN MO
63074-3303
US

V. Phone/Fax

Practice location:
  • Phone: 314-488-5447
  • Fax: 314-488-5447
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number2018039877
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: