Healthcare Provider Details

I. General information

NPI: 1184879413
Provider Name (Legal Business Name): SAOVAROT K BRYANT ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BELLEVUE AVE SUITE 200
SAINT LOUIS MO
63117-1851
US

IV. Provider business mailing address

12855 N. FORTY DRIVE SUITE 300
ST. LOUIS MO
63141-8666
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-6450
  • Fax: 314-645-2560
Mailing address:
  • Phone: 314-880-6100
  • Fax: 314-997-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2005040460
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2005040460
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2005040460
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: