Healthcare Provider Details

I. General information

NPI: 1649380122
Provider Name (Legal Business Name): PROSPECTIVE HEALTHCARE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/28/2007
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON WOOTEN
Title or Position: OWNER/SENIOR CONSULTANT
Credential:
Phone: 636-724-7539